BCH Registration Form

First name

Last name

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Name address and contact info for Emergency Contact

Height

Weight

How did you hear about BC Helicopters?

Which course will you be attending?

Which class start date are you applying for?

Have you previously attended ground school?

Yes

Is this training sponsored by WCB due to workplace injury?

Yes

Is your course funded by HRDC or any other government agency?

Yes

Please provide details of your education, list most recent first.

Please provide details of your work experience, list most recent first.

Please choose any of the following that apply to you.

I have a learning or reading disability

Dyslexia

Attention Deficit Disorder

Colour-Blind

Wear contact lenses for flying

HIV/AIDS

Currently on medication

Have allergies

Heart Problems

Have you ever been charged for impaired driving or illegal drug use?

Have you ever started helicopter training at another flight school prior to starting here?

Yes

Have you been denied flight training at another school?

Yes

Please explain in your own words why you wish to fly helicopters and any future goals.

Please provide three contacts as a reference. Name/Position/Contact Info

Privacy Statement

The personal information provided by the applicant in this form is being collected under the authority of the Freedom

of Information and Protection of Privacy Act (FOIPP) and the Personal Information and Electronic Documents Act

(PIPEDA). Information is collected and used solely for the purposes of administerinq fliqht traininq proqrams and will

only be used by authorized staff. Certain personal information may be made available to federal and provincial

qovernment departments and aqencies under appropriate leqislative authority. By siqninq below, the applicant

consents to the collection and use of the information in this document for the above purposes.

Applicant Declaration

I (the undersiqned) hereby declare that, to my knowledqe, the information I have provided is accurate. I understand

that acceptance to a course is conditional upon an interview with British Columbia's Chief Fliqht Instructor and the

number of students already enrolled in that course.

Signature

Signature field is empty.

Date

Year

Month

Day

The following is for office use only

Cat 1 Medical

Interview Date

Course Start

Introductory Flight

Deposit Received

BCH Registration Form

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