Trial Request Form

Student's Name*
Last Name
First Name
Birth Date*
Gender*
Address*
Street #/Apartment#
City
Province
Postal code
Country
Phone Number
Home* (format: xxx-xxx-xxxx)
Alternate*
Emergency Contact
Last Name
First Name
Phone Number
E-mail*
 
Program*
 
Program interests*
 
Educational Background*
Name of School
Trial Day
 
Trial Date*
Select the date so we can arrange the schedule for the trial class. Thinnox counsellor will contact you regarding the confirmation.
Time option*
 
How did you hear about Thinnox?
(YOU MUST BE 18 YRS OR OLDER, OR A PARENT/GUARDIAN TO SUBMIT THIS FORM.)

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