Student Registration Form Student Registration Form POLICIES Refunds I have read and understood the Refund Policy. Student Cancellations I understand that if I cancel or miss a class for any reason (e.g. sickness, family emergency, travel, etc.) PT Exam Prep will not be responsible for providing me with a replacement class. I understand that PT Exam Prep operates like any other University or formal educational institution. Student Course Changes I understand that once I select and pay for a course, that I have made a commitment to attend. If for any reason I need to change the course I am registered in, I understand that I will only be able to do so if (1) PT Exam Prep is able to find a replacement student for my seat, (2) I can only move into another course that has already been scheduled by PT Exam Prep and has an availability in it, and (3) I agree that I will pay a $50 administration fee for the course change. Privacy I consent to the collection, use, and retention of all personal information in this application form by PT EXAM PREP, and to the use of this information as outlined in the Privacy Policy. Spam I provide express consent to PT EXAM PREP to communicate with me using the email address I provide in my application. This includes future student information updates, announcements, event/seminar invitations, surveys, contests and other notifications. This also includes the sharing and exchanging of any personal information I provide in the application, as defined in the Privacy Policy. Sharing of Contact Information with Classmates I provide express consent to PT EXAM PREP to share the email address and phone number I provide in this application form with my teacher and any other students that are registered for the same course as myself. In-Person Restrictions I understand that if Provincial Health Authorities restrict PT Exam Prep from safely conducting in-person, face-to-face courses, my course will change to a live virtual course or I am enrolled in a virtual course so changes made by Provincial Health Authorities won’t effect my course. Confidentiality I understand I will be provided with course materials that are considered the intellectual property of PT Exam Prep. I hereby agree that I will not at any time or in any manner, either directly or indirectly use the course materials for personal benefit, gain or advantage. I will not share the course materials with others, leave them unattended, or stored in an unsecure location (both physically and digitally). Proprietary course materials include but are not limited to: all student course hand-outs, questions, answers and photos/charts. All mock exam questions and answers. STUDENT INFORMATION First & Last Name * Pronouns She/HerHe/HimThey/ThemOther Let us know how to refer to you. Not a required field. Address * City * Province * Postal Code * Email Address * Confirm Email Address * Primary Phone * Alternate Phone From what school did you graduate? * Have you attempted this exam before? * Yes, once before.Yes, this is my last chance.No, this is my first attempt. What are you areas of strength and weakness? (This information will be shared with your teacher before the class begins) * Course Type * WrittenClinical When will you be taking your exam? * Written PCE - January 15th, 2024Written PCE - February 21st, 2024Written PCE - March 9th, 2024Written PCE - April 17th, 2024Written PCE - May 13th, 2024Written PCE - July 6th, 2024Written PCE - August 14th, 2024Written PCE - September 14th, 2024Written PCE - October 9th, 2024Written PCE - November 18th, 2024Written PCE - in 2025 or beyondOntario Clinical Exam - January 20th or 21st, 2024BC Alternate Clinical Evaluation - February 24th, 2024Alberta Post-Graduate Clinical Examination - February 25th and 26th, 2024Ontario Clinical Exam - March 4th or 5th, 2024Alberta Post-Graduate Clinical Examination - April 27th or 28th, 2024BC Alternate Clinical Evaluation - May 25, 2024Ontario Clinical Exam - June 1st or 2nd, 2024BC Alternate Clinical Evaluation - August 24, 2024Alberta Post-Graduate Clinical Examination - October 19th or 20th, 2024Ontario Clinical Exam - October 25th or 26th, 2024Ontario Clinical Exam - January 24th or 25th, 2025Ontario Clinical Exam - March 28th or 29th, 2025Clinical Exam - later in 2025 or beyond When will you be taking your exam? Which course are you registering for? * BC's Alternate Clinical Evaluation CourseAlberta's Post-Graduate Clinical Evaluation CourseOntario's Clinical Exam CourseLive Teacher Virtual Written CoursePremium Access Video CourseBasic Access Video CourseCanadian Student Written Course FEEDBACK How did you hear about PT Exam Prep? * FriendInternet SearchFacebookInstagramFree WebinarsOther How did you hear about PT Exam Prep? If you selected "Other" above, please tell us how you heard about us! reCAPTCHA