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Student First Namerequired

Student Last Namerequired

Parent's Namerequired

Student's Current Schoolrequired

Student's Street Addressrequired

Cityrequired

Zip Coderequired

Parent's cell phonerequired

Please provide a contact phone number for at least one of the student's parents/guardians.

Parent's Email Addressrequired

Please provide a contact email for at least one of the student's parents/guardians.

Emergency Contactrequired

Emergency Contact Phone Numberrequired

Registration*

Entrance Exam Tutorial Course $75

After you click submit at the bottom of this form, you will be brought to a payment page to complete your registration.

If you have additional questions, please contact Tom Weislo in the Canisius admission office at weislo@canisiushigh.org.

Additional Information

If there is any additional information we should know about this student, please add it here.

Text Messages

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Cell Phone

Or, check this box if the cell phone where you'd like to receive texts is the same as the phone number you previously entered

Same as above

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