Welcome to :: CATAPULTED

Name *		:

Birth Date		:

Class *		:

School		:

Address *		:

Phone Number		:

Email ID *		:

Career Interests		:	1.

			2.

			3.

Hobbies & Interests		:

	I understand and agree that as a Catapult-ed student, I will conduct myself in a responsible manner. I will exercise sound judgement regarding my behaviour at all times.

Parental Permission:

Parent/Guardian Name *	:

Phone Number	:

Mother's Occupation	:

Father's Occupation	:

I agree that my son/daughter has my permission to attend this event.