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      <!-- Section Content -->
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            <h2 class="title text-white text-center">Online Registration</h2>
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        </div>
      </div>
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  </section>

  <!-- Section: About -->
  <section id="about">
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        <div class=" p-30 pt-10 mb-0 col-md-12">
          <h3 class="text-danger  text-center mt-0 pt-5">The Educators Academy <!--<span>(High School Registration Form)</span>--></h3>
          <div class="tags text-center"><strong>Address:</strong> Unit 202, 9715 James Potter Road, L6X3B9 Brampton ON </div>

          <div data-example-id="simple-table" class="bs-example" style="background: #2d825a;color: #fff;">
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                <tr>
                  <td><strong>Tel:</strong> 905-654-4646 </td>

                   <td ><strong>Email:</strong>  info@educatorsacademy.ca</td>
                  <td><strong>Website:</strong> www.educatorsacademy.ca</td>
                </tr>

                <tr>

                  <td><strong>BSID:</strong> 888750 </td>
                  <td><strong>Grade 9-12 Credit Courses</strong> </td>
          <td>&nbsp;</td>

                </tr>
              </tbody>
            </table>

          </div>

          <form  action="<?php echo e(route('student.registerStudent')); ?>" method="post" enctype="multipart/form-data" >
          <div class="bg-lightest border-1px p-10 mb-20">

            <!-- <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Date Received by School: <small>*</small></label>
                  <input name="form_name" type="text"  required="" class="form-control" aria-required="true">
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              <div class="col-sm-6">
                <div class="form-group">
                  <label>Admission NO <small>*</small></label>
                  <input name="form_email" class="form-control" type="text"  aria-required="true">
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                  <label>Date of Start of Course: <small>*</small></label>
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              <div class="col-sm-6">
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                  <label>End Date of Course: <small>*</small></label>
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<h4 class="line-bottom line-bottom2 mt-0 mt-sm-20 text-red">ACADEMIC PROGRAM COURSE APPLYING FOR  </h4>
            <div class="row">
              <div class="col-sm-12">
                <div class="form-group">
                  <label>Selected Grade / Course : <small>*</small> <u><?php echo e($course->grade->name); ?></u></label><br/>
                  <!-- <div class="col-md-3 pl-0"><input  id="blankCheckbox" type="checkbox" value="option1">&nbsp;Grade 9</div>
                  <div class="col-md-3 pl-0"><input id="blankCheckbox" type="checkbox" value="option2">&nbsp;Grade 10</div>
                  <div class="col-md-3 pl-0"><input  id="blankCheckbox" type="checkbox" value="option3">&nbsp;Grade 11</div>
                  <div class="col-md-3 pl-0"><input  id="blankCheckbox" type="checkbox" value="option4">&nbsp;Grade 12</div> -->

                </div>
              </div>

              <div class="col-sm-12 mt-10">
                <div class="col-sm-2 pl-0">
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                  <label>Course Code : <small>*</small></label>
                  <input name="course_code" required value="<?php echo e($course->name); ?>" readonly class="form-control " type="text"  aria-required="true">
                  <input type="hidden" name="course_id" required value="<?php echo e($course->id); ?>" />
                  <input type="hidden" name="grade_id" required value="<?php echo e($course->grade->id); ?>" />
                </div>
              </div>
              <div class="col-sm-5 pl-0">
                <div class="form-group">
                  <label>Course Name : <small>*</small></label>
                  <input name="course_name" value="<?php echo e($course->name); ?>" required readonly class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-3 pl-0">
                <div class="form-group">
                  <label>Availability(# of days): <small>*</small></label>
                  <input name="availablity" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>

              <div class="col-sm-2 pl-0">
                <div class="form-group">
                  <label>Duration: <small>*</small></label>
                  <input name="duration" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
            </div>
            </div>

            <h4 class="line-bottom line-bottom2 mt-0 mt-sm-20 text-red">STUDENT INFORMATION </h4>
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              <div class="col-sm-6">
                <div class="form-group">
                  <label>Family Name: <small>*</small></label>
                  <input name="family_name" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Given Name: <small>*</small></label>
                  <input name="given_name" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>OEN: <small>*</small></label>
                  <input name="oen" class="form-control" required type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Any Medical / Allergy condition: <small>*</small></label>
                  <input name="medical" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
            </div>
            <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Gender: <small>*</small></label>
                  <select class="form-control" required name="gender">
                    <option value="Male">Male</option>
                    <option value="Female">Female</option>
                    <option value="Others">Others</option>
                  </select>

                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Date of Birth (dd/mm/yy): <small>*</small></label>
                  <input name="dob" class="form-control" type="date"  aria-required="true">
                </div>
              </div>
            </div>
            <div class="row">
              <div class="col-sm-12">
                <div class="form-group">
                  <label>Proof of Canadian Residency   (Please encircle): <small>*</small></label><br/>
                  <div class="col-md-4 pl-0"><input name="residency" checked id="optionsRadios4" type="radio" value="Canadian Citizen">&nbsp;Canadian Citizen</div>
                  <div class="col-md-4 pl-0"><input name="residency" id="optionsRadios4" type="radio" value="Health Card">&nbsp;Health Card</div>
                  <div class="col-md-4 pl-0"><input name="residency" id="optionsRadios4" type="radio" value="PR Card">&nbsp;PR Card</div>
                  <div class="col-md-4 pl-0"><input name="residency" id="optionsRadios4" type="radio" value="Passport">&nbsp;Passport</div>
                  <div class="col-md-4 pl-0"><input name="residency" id="optionsRadios4" type="radio" value="Driving License">&nbsp; Driving License</div>
                  <div class="col-md-4 pl-0"><input name="residency" id="optionsRadios4" type="radio" value="Others">&nbsp; Others</div>
                  <br/><br/>

                </div>
              </div>

            </div>
            <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Status in Canada: <small>*</small></label>
                  <input name="status_canada" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Email: <small>*</small></label>
                  <input name="email" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>

              <div class="col-sm-6">
                <div class="form-group">
                  <label>Password: <small>*</small></label>
                  <input name="password" required class="form-control" type="password"  aria-required="true">
                </div>
              </div>
            </div>

            <div class="row">
              <div class="col-sm-4">
                <div class="form-group">
                  <label>Street Name & No : <small>*</small></label>
                  <input name="street" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-4">
                <div class="form-group">
                  <label>Apart / Unit : <small>*</small></label>
                  <input name="apart" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-4">
                <div class="form-group">
                  <label>Postal code: <small>*</small></label>
                  <input name="postal" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
            </div>

            <div class="row">


              <div class="col-sm-6">
                <div class="form-group">
                  <label>City: <small>*</small></label>
                  <input name="city" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Province: <small>*</small></label>
                  <input name="province" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>

            </div>

        <div class="row">


              <div class="col-sm-6">
                <div class="form-group">
                  <label>Home Phone No: </label>
                  <input name="home_phone" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Cell No: <small>*</small></label>
                  <input name="cell_no" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>

            </div>
            </div>

            <h4 class="line-bottom line-bottom2 mt-0 mt-sm-20 text-red">SCHOOL INFORMATION </h4>
            <div class="bg-lightest border-1px p-10 mb-20">
            <div class="row">
              <div class="col-sm-12">
                <div class="form-group">
                  <label>Name of most recent year school attended : <small>*</small></label>
                  <input name="last_school" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>

            </div>

            <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Last Grade Attended: <small>*</small></label>
                  <input name="last_grade" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>School Name & Address: <small>*</small></label>
                  <input name="school_address" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
            </div>
            <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>School Phone no : <small>*</small></label>
                  <input name="school_phone" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Last Year Attended: <small>*</small></label>
                  <input name="last_year" required class="form-control" type="text"  aria-required="true">
                </div>
              </div>
            </div>

            </div>


            <div class="bg-lightest border-1px p-10 mb-20">



            <h4 class="line-bottom line-bottom2 mt-0 mt-sm-20 text-red">PARENT / GUARDIAN CONTACT </h4>
            <div class="bg-lightest border-1px p-10 mb-20">
            <div class="row">
              <div class="col-sm-12">
                <div class="col-sm-4 pl-0">
                <div class="form-group">
                  <label>Relationship: <small>*</small></label>
                  <input name="relationship" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-4 pl-0">
                <div class="form-group">
                  <label>Complete Name: <small>*</small></label>
                  <input name="parent_name" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>
              <div class="col-sm-4 pl-0">
                <div class="form-group">
                  <label>Phone: <small>*</small></label>
                  <input name="parent_phone" required class="form-control " type="text"  aria-required="true">
                </div>
              </div>

              </div>


            </div>


            </div>


            <h5 class="line-bottom line-bottom2 mt-0 mt-sm-20 text-red">I have provided the following supporting documents (PLEASE ENCIRCLE)	</h5>
            <div class="col-sm-12 pl-0">
                <div class="form-group">

                  <div class="col-md-3 pl-0"><input name="document" selected id="optionsRadios4" type="radio" value="identification">&nbsp;Identification</div>
                  <div class="col-md-3 pl-0"><input name="document" id="optionsRadios4" type="radio" value="report_card">&nbsp;Report Card  </div>
                  <div class="col-md-3 pl-0"><input name="document" id="optionsRadios4" type="radio" value="credit_summary">&nbsp;Credit Summary</div>
                  <div class="col-md-3 pl-0"><input name="document" id="optionsRadios4" type="radio" value="others">&nbsp;Other</div>

                  <br><br>

                </div>
              </div>
      <p>
<ul>
<li>1) I hereby declare that information given in this application form is to the best of my knowledge complete and correct </li>
<li>2)  If I am accepted as a student at Educators Academy, I hereby agree to abide by all the rules and regulations of the School</li>
<li>3) School shall under no circumstances be liable for any loss, damage or injury </li>
<li>4) The Admission will not confirmed untill all the Pre-requsite are completed and full payment are recieved. Moreover, I hereb acknowmledge that I will not be granted a Credit without completing a minimum of 110 hours in class for each course taken.
</li>
<li>5) The Educators Academy may record, film, photograph, audiotape or videotape work of a student, your child’s photograph and performance to display, publish or distribute these Works for publishing, posting on the school website, posting in schools and/or posting on social media sites. The information collected may also be used for marketing purpose</li>
<li>6) Parents/Guardians must call the school office well in advance if you are absent due to sickness or family emergency. If you know student will be absent from school due to scheduled appointments, inform the office 3 hours before the class time.</li>
</ul>
</p>
      <div class="row">
              <div class="col-sm-12">
                <div class="form-group">
                  <label>How you got info for our School (Please encircle): <small>*</small></label><br>
                  <div class="col-md-2 pl-0"><input name="refrence" checked id="optionsRadios4" type="radio" value="google">&nbsp;Google </div>
                  <div class="col-md-2 pl-0"><input name="refrence" id="optionsRadios4" type="radio" value="flyer">&nbsp;Flyer </div>
                  <div class="col-md-2 pl-0"><input name="refrence" id="optionsRadios4" type="radio" value="referral">&nbsp;Referral </div>
                  <div class="col-md-2 pl-0"><input name="refrence" id="optionsRadios4" type="radio" value="signboard">&nbsp;Signboard</div>
                  <div class="col-md-2 pl-0"><input name="refrence" id="optionsRadios4" type="radio" value="others">&nbsp; Others</div>
                  <br><br>

                </div>
              </div>

            </div>

            <div class="row">
              <div class="col-sm-12">
                <div class="form-group">
                  <label>CAD $ Amount (how you will pay): <small>*</small></label><br>
                  <div class="col-md-2 pl-0"><input name="payment_type" checked id="optionsRadios4" type="radio" value="cash">&nbsp;Cash </div>
                  <div class="col-md-2 pl-0"><input name="payment_type" id="optionsRadios4" type="radio" value="credit/debit card">&nbsp;Credit/Debit transfer</div>
                  <div class="col-md-2 pl-0"><input name="payment_type" id="optionsRadios4" type="radio" value="cheque">&nbsp;Cheque</div>
                  <div class="col-md-2 pl-0"><input name="payment_type" id="optionsRadios4" type="radio" value="email">&nbsp;Email</div>
        <div class="col-md-2 pl-0"><input name="payment_type" id="optionsRadios4" type="radio" value="others">&nbsp; Others</div>
                  <br><br>

                </div>
              </div>

            </div>

      <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Signature of Applicant / Guardian: <small>*</small></label>
                  <input name="signature_name" required class="form-control " type="text" aria-required="true">
                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group">
                  <label>Name of Parent or Guardian (if applicant is under 18): <small>*</small></label>
                  <input name="name_signature" required class="form-control" type="text" aria-required="true">
                </div>
              </div>
            </div>


            <h4 class="line-bottom line-bottom2 mt-0 mt-sm-20 text-red">REFUND POLICIES</h4>
           <ul>
           <li> 1. Application/ Registration fee and other administrative charges are non-refundable and are included  in the tuition fee. If a student with-draws after the registration 25% of the amount will be deducted from total course fee. Moreover, no tuition fee will be refunded after the commencement of the course. </li>
<li>2. Every course needs to be finished in time and on schedule. If there are any excused absences, you need to make up for the missed work within the course schedule. You are only  allowed to have maximum three excused absences during the course schedule. </li>
<li>3.  Your course cannot be extended beyond the course end date. If needed, student will have to  pay $25 / day for each extended day. If student do unncecessary delay in the course , 3 verbal and written  warnings will be given. After 3 written warnings,  school will terminate the student from particular course and no refund will be given.	</li>
<li>4. School will send report card by registered mail. For urgent delievery postal charges will be applied. </li>

</ul>


         <div class="form-group mt-10">
                <label>Any Special Note </label>
                <textarea name="notes"  class="form-control required" rows="5" aria-required="true"></textarea>
              </div>

            <div class="row">
              <div class="col-sm-6">
                <div class="form-group">
                  <label> Principal: <span style="font-style:italic; text-decoration:underline">Anila Shakeel OCT </span></label>

                </div>
              </div>
              <div class="col-sm-6">
                <div class="form-group text-right">
                  <label> Director: <span style="font-style:italic; text-decoration:underline">Nasir Iqbal </span></label>
                </div>
              </div>
            </div>


            <div class="form-group col-md-offset-4">
               <?php echo e(csrf_field()); ?>

               <button type="submit" class="btn  btn-dark btn-theme-colored btn-lg mt-20 pt-10 pb-10" data-loading-text="Please wait...">Register For Course Now</button>
            </div>
          </form>
          <!-- Job Form Validation-->

        </div>
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  </section>
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