Applications

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 (DD/MM/YY)

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
Email: explore@pinehurst.on.ca
Web: www.pinehurst.on.ca

APPLICATIONS

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