BrightBridge Secondary School

Registration Form

Student’s Legal Full Name: *

Street Address: *

City: *

Postal Code: *

Student Status: *

Country Of Citizenship: *

First Language Of The Student: *

Birth Date: *

Gender: *

Which Grade Do You Wish To Enroll: *

Student’s Home Telephone: *

Student Mobile No:

Any Medical Problem/Allergies:

Name Of The Current School: *

Last Grade Completed: *

Mother’s/Father’s Name: *

Mailing Address: *

Guardian's Phone Number: *

Mother’s AND/OR Father’s e-mail address: *

Student Name: *

Student Email: *

Create Password: *

Confirm Password: *

Signature Of Parent/Guardian: *

Agent Code:

Upload Documents:

I hereby declare that I have read and understood the information contained on this form and the information I have provided is correct.

Date: *

Student Signature: *