NOTE: If you have not already, please contact Customer Service for tuition payment arrangements in addition to filling out this form.

If you have never registered with LCA previously, please fill out the LCA Online Registration Form for new students instead.

Family Information

Address*:

City*:

Province*:

 

Postal Code*:

 

Home Phone*:

 

Work Phone:

 

Cell Phone:

 

Email Address:

 

Parents/Guardians Names*:

 

Student Information (fill out at least one)

1) Student's Name*:

 

Birth Date*:

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025    1 2 3 4 5 6 7 8 9 10 11 12    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2) Student's Name:

 

Birth Date:

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015    1 2 3 4 5 6 7 8 9 10 11 12    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

3) Student's Name:

 

Birth Date:

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015    1 2 3 4 5 6 7 8 9 10 11 12    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

4) Student's Name:

 

Birth Date:

1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015    1 2 3 4 5 6 7 8 9 10 11 12    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Please list other information regarding the student that may be of assistance to the LCA Advisor:

* = Requried fields

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