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Recruitment Information Form

First Name:
Last Name:
Date of Birth (YY/MM/DD): / /
Gender: MaleFemale
Street Address 1:
Street Address 2:
City / Town:
Province:
Postal Code (no spaces):
Telephone:
Cell Phone:
Email Address:
Current Grade: 10
11
12
Other:
Current School
Programs of Interest:
Sports Played (if any):

140 Weymouth Street  •  Charlottetown, PE  •  Canada  •  C1A 4Z1  •  info@hollandcollege.com  •  1-800-446-5265