Food Service Safety Course

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Personal information on this form is collected under the authority of the Public Heatlh Act, Chapter P-30.1, Section 11, and the Public Health Act, Chapter P-30.1 Public Health Act Food Premises Regulations, Section 5(2) and Section 24(5) as they relate to the operation of a food premise. If you have any questions about the collection or use of this personal information, you may contact Environmental Health, at 902-368-4970 or toll free at 1-800-958-6400.

Identification

Are you registering as an individual or for a group?

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address