This page is a preliminary online application for admission to Pinehurst School.  The information you submit is secure and private.  You will be contacted regarding this application shortly.  Thank-you for your interest in Pinehurst.

Student's Name
Student's Date of Birth
Present Academic Grade
Mother's Name
Father's Name
Mailing Address: Apt, Street
City, Province/State
Country
Postal Code/Zip Code
Daytime Telephone with Area Code
Evening Telephone with Area Code
Fax Machine with Area Code
Email Address
Has the student ever been identified as in need of special education?  If so, please provide identification dates and particulars.
Does the student have any allergies, physical limitations, or other medical conditions?  If so, please provide particulars, including any precluded physical activities.
Is the student receiving any prescribed medication(s)?  If so, please provide the name of the medication, and both the dosage amount and frequency.
What are you family's three (3) most important educational expectations at Pinehurst School?
By submitting this online application, you are authorizing us (Pinehurst School) to contact you, using the information submitted as reference for communications.  Submitted information is regarded as confidential and private, and will be treated with professional care and attention.
10 Seymour Avenue St. Catharines, ON  L2P 1A4 Phone 905-641-0993 Fax 905-641-0399 Contact: explore@pinehurst.on.ca Home Page: www.pinehurst.on.ca