Script to Screen Registration
Name
Name
*
First
Last
Student Number
*
Maximum of
9
characters allowed.
Currently Entered:
0
characters.
Begins with 100xxxxxx
Ontario Tech Email
*
Primary Contact Number
Primary Contact Number
*
-
###
-
###
####
Secondary Contact Number
Secondary Contact Number
*
-
###
-
###
####
Have you read and signed the Risk Form for this course. If no, Read and sign the form before proceeding
*
Have you read and signed the Risk Form for this course. If no, Read and sign the form before proceeding
Yes
No
Comments
Maximum of
500
words allowed.
Currently Entered:
0
words.
Draw your signature into the box below.
Draw
or
Type
I understand this is a legal representation of my signature to sign up for *insert course name* course and i have read, understood and accepted the risks involved through the risk form
Clear
Full Name
I understand this is a legal representation of my signature to sign up for *insert course name* course and i have read, understood and accepted the risks involved through the risk form