Grande Prairie Public School District #2357 Student Registration Form

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1 OFFICE USE Grande Prairie Public School District #2357 Student Registration Form STUDENT INFORMATION SCHOOL ID: ENROLLING IN GRADE: LEGAL LAST NAME LEGAL FIRST NAME LEGAL MIDDLE NAME(S) PREFERRED LAST NAME PREFERRED FIRST NAME DATE OF BIRTH (MM/DD/YYYY) - Copy of Birth Certificate Required HOME PHONE AGE GRADE GENDER ALBERTA HEALTH CARE # [ ] Male [ ] Female MAILING ADDRESS (Street / City) POSTAL CODE PHYSICAL ADDRESS - if different from MAILING: (Street Address or Trailer/Lot or Subdivision/Lot or House #, County Address) Do you live in the: [ ] City of Grande Prairie [ ] County of Grande Prairie [ ] Other PREVIOUS SCHOOL (Complete CUM Request) PREVIOUS SCHOOL - City and Province / Country LAST GRADE COMPLETED Has the student attended school in Grande Prairie Public School District before? [ ] Yes [ ] No If YES, where (School): Year: Has the student attended school in Alberta before? [ ] Yes [ ] No If YES, where (Town/City): Year: Does the student have siblings attending this or another GPPSD school? [ ] Yes [ ] No If YES, sibling s name: Grade: School Information (newsletters, attendance etc.): [ ] Yes Callouts to Phone Number [ ] Yes Independent Student Status: [ ] I Declare I am 16 or older and living on my own. PARENT / GUARDIAN INFORMATION Student lives with: [ ] Mother [ ] Father [ ] Guardian(s) [ ] Self [ ] Other: MOTHER Relation to student: (i.e. stepmother/grandmother, etc.) LAST NAME: FIRST NAME: ADDRESS: (if different from student): FATHER Relation to student: (i.e. stepfather/grandfather, etc.) LAST NAME: FIRST NAME: ADDRESS: (if different from student): Postal Code Cell Ph: Postal Code Cell Ph: Home Ph: Work Ph: ext Home Ph: Work Ph: ext GUARDIAN Relation to student: (i.e. stepmother/grandmother, etc.) LAST NAME: FIRST NAME: ADDRESS: (if different from student): GUARDIAN Relation to student: (i.e. stepmother/grandmother, etc.) LAST NAME: FIRST NAME: ADDRESS: (if different from student): Postal Code Cell Ph: Postal Code Cell Ph: Home Ph: Work Ph: ext Home Ph: Work Ph: ext CUSTODY (If applicable) Are there any court orders affecting access to the student: [ ] Yes [ ] No (Note: Copies of Court Documents are required) If YES, please describe: Section # Teacher name: Boundary Documentation: Yes [ ] Boundary Exemption [ ] Program of Choice [ ] ECS: Full Day- M/W-Track A [ ] T/T-Track B [ ] Half-Day AM-Track C [ ] PM-Track D [ ] Birth Certificate: Yes [ ] No [ ] Fees Paid: Bus Eligible: Yes [ ] No [ ] P&P Teen Program [ ] Grande Prairie Public School District STUDENT REGISTRATION FORM v4.8 Page 1 French Immersion [ ] Regular [ ] Late Entry Course Funding: [ ] Self [ ] Worker s Comp [ ] Youth Connections [ ] Human Resources [ ] Worker s Comp [ ] Band [ ] CFSA (office) [ ] Other

2 MEDICAL / EMERGENCY INFORMATION EMERGENCY CONTACT #1 (Other than parents) EMERGENCY CONTACT #2 (Other than parents) Relation to student: (i.e. stepmother/grandfather, etc.) LAST NAME: FIRST NAME: Home Ph: Cell Ph: Work Ph: ext Relation to student: (i.e. stepfather/grandfather, etc.) LAST NAME: FIRST NAME: Home Ph: Cell Ph: Work Ph: ext MEDICAL CONSIDERATIONS Medical conditions or problems the school should know about? Please describe briefly: Do you consider this a serious (life threatening) alert? [ ] Yes [ ] No STUDENT S SPECIAL NEEDS Describe any special educational supports or services your child currently receives or has received in the past. STUDENT S CITIZENSHIP STATUS [ ] Canadian Citizen (Copy of Birth Certificate or Canadian Passport Required) [ ] Permanent Resident (Copy of Birth Certificate &Canadian Permanent Resident Card Required) [ ] Temporary Resident (Copy of Birth Certificate & Canadian Immigration Papers / Student Visa Required) [ ] Child of Canadian Citizen (Copy of Birth Certificate & Copy of Canadian Parent s Birth Certificate Required) [ ] Other (Please explain): ENGLISH AS A SECOND LANGUAGE Is English the student s first language spoken at home? [ ] Yes [ ] No If NO, what is the first language spoken at home: STUDENT S ABORIGINAL STATUS If you wish to declare that you are an Aboriginal Person, please specify: [ ] Status Indian/ First Nations [ ] Non-Status Indian/ First Nations [ ] Metis [ ] Inuit Alberta Education is collecting this personal information pursuant to section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act as the information relates directly to and is necessary to meet its mandate and responsibilities to measure system effectiveness over time and develop policies, programs and services to improve Aboriginal learner success. Alberta school boards are also collecting this information pursuant to the same section in conjunction with section 2(1)(t) of the Student Record Regulation and for the same purposes. This information will also be used to determine the provincial First Nations, Métis and Inuit Funding Allocation provided to school authorities. For further information or if you have questions regarding the collection activity, please contact the office of the Director, Aboriginal Policy, Strategic Services Division, Alberta Education, Street, Edmonton AB, T5J 4L5, (780) If you have questions regarding the collection activity by the Grande Prairie Public school board, please contact the Grande Prairie Public School Board Superintendent at (780) SECTION 23 FRANCOPHONE EDUCATION ELIGIBILITY DECLARATION (To be completed by all Parents) Citizens of Canada Whose first language learned and still understood is French; or Who have received their primary school instruction in Canada in French have the right to have their children receive primary and secondary instruction in French; or Of whom any child has received or is receiving primary or secondary school instruction in French in Canada, have the right to have all their children receive primary and secondary school instruction in the same language. In Alberta, parents can only exercise this right by enrolling their child in a French first language (Francophone) program offered by a Francophone Regional Authority. Please put an X in the appropriate box: A) According to the criteria above as set out in the Canadian Charter of Rights and Freedoms, are you eligible to have your child receive a French first language (Francophone) education? [ ] Yes [ ] No B) Do you wish to exercise your Section 23 rights to have your child receive a French first language (Francophone) education? [ ] Yes [ ] No DECLARATION I declare that all the information on this form is, to the best of my knowledge, accurate. I agree to inform the Administration Office at the school, in writing, if any changes to this information should occur. Signature: Date: (Parent/Guardian/Independent Student) Grande Prairie Public School District STUDENT REGISTRATION FORM v4.8 Page 2

3 9625 Prairie Road Grande Prairie, Alberta T8V 6G5 (780) Phone (780) Fax March 16, 2016 Attention: Re: All Parents of Grande Prairie Public School District students Aboriginal Data Collection Initiative Tansi! Parent(s) and Guardian(s), As you register your child (children) for the school year, please take the time to look at the Aboriginal Self- Identification question on the form. If you or your child (children) identify as First Nations, Métis, Non-Status or Inuit, you can identify under the Alberta Education Aboriginal Data Collection Initiative. Please note, you do not need to have a treaty or Métis card to self-identify. Self-declaration is voluntary and is collected pursuant to Section 33 of the Freedom of Information and Protection of Privacy Act and will be kept strictly confidential. In self-identifying your child (children) this information is then used as part of the funding calculation for our District. The funding is then allocated to the District FNMI Program, which houses the FNMI Program Team for our schools as well as, allows us to develop culturally appropriate professional development for our Administration, teachers and staff, along with cultural activities and other supports for our students at the school and district level. If you have any questions regarding the Aboriginal Data Collection Initiative, please feel free to contact me. In Friendship, Shannon Dunfield District Coordinator (780)

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5 Freedom of Information and Protection of Privacy Act (FOIP Act) Collection of Personal Information (s.33 FOIP Act) The information collected on the Student Registration Form is personal information as referred to in the FOIP Act. It is collected as per the School Act and section 32(c) of the FOIP Act. The Grande Prairie Public School District No believes this information is necessary and relates directly to our obligation to provide students with an education program that meets their needs and the provision of a safe and secure school environment. The Grande Prairie Public School District #2357 believes that the uses of personal information as listed below provides a vital, healthy, functioning school where participation of all students is important and encouraged: The use of student s names, photos and comments, in the school calendar, newsletter, yearbook, graduation book, district or school website or other school publications The taking of individual, class, team or club photos for school purposes The use of students name on artwork, other creative work, material of students, displayed at school or school board sites, or at a school or school board sponsored display in the community The use of students names on honour rolls, student lists, graduation ceremonies, scholarship or other awards within the school or school district. The use of students names and academic information necessary for determining eligibility or suitability for provincial, federal or other types of awards or scholarships in the event the board applies on a student s behalf. The use of students names, related contact information and telephone numbers for absenteeism verification. The use of students names, addresses, grades, age, contact information and telephone numbers by the Peace Country Health Authority for immunization and health screening purposes. I am aware of and agree to the above (Parent/guardian signature) There are occasions where photos are taken of students at school sponsored activities by media, for publication, where students are not identified by name, such as: photographs or videos of students on the playground, taking part in music or sporting events or simply watching an event, etc. I grant permission to the Grande Prairie Public School District #2357 to allow my child s picture to be used in the above manner. (Parent/guardian signature) If the media wishes to identify your child by name you will be contacted for your consent before the picture or article is published. FOIP legislation recognizes that work produced by students at school is the property of the student. There are many occasions at school where it is advantageous to record, display or reproduce student work, such as: taping student s oral class presentations, displaying student work in the school or at school sponsored events or reproducing student s work for educational or promotional reasons, etc. I grant permission to the Grande Prairie Public School District #2357 to use my child s work for non-profit educational purposes as outlined above. (Parent/guardian signature) Signed this day of, 20, on behalf of (Student s name) If you have any questions or concerns regarding the collection of this information and the intended purposes, please contact the Principal at your school, or the FOIP Coordinator for the Grande Prairie Public School District #2357 at Street or phone Grande Prairie Public School District Student Registration Form Page 1 of 1 March 11, 2011

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7 Grande Prairie Public School District # Street Grande Prairie, AB T8V 2H3 Phone: Fax: We want to continue to keep you up-to-date and informed about the latest school and school board information, events and announcements through electronic communications such as s, texts, phone messages, newsletters, and social networking sites from Grande Prairie Public School District, its schools, school councils and the Educational Foundation. Occasionally these communications may include information about offers, advertisements or promotions related to school activities such as school fees, yearbooks, school clothing, field trip opportunities, student photos, fundraising events or similar school related activities. Canada s new Anti-Spam Law came into effect on July 1, 2014, without your consent we may be unable to send you these types of communications electronically. To receive these communications please indicate your consent below. Please note that if you do not respond we may be unable to continue to send you electronic communications. If you have any questions or wish to withdraw your consent at any time, please contact the school or Central Office at Student Name: School: Parent/Guardian Name: I consent to GPPSD, its schools, school councils and the Educational Foundation to send commercial electronic messages (CEM). I DO NOT consent to GPPSD, its schools, school councils and the Educational Foundation to send commercial electronic messages (CEM).

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9 Avenue Grande Prairie, AB T8V 6L5 (780) FAX (780) Dear Parents, In the fall, all children in kindergarten will be screened by a member of the Speech-Language Pathology department or the school staff to determine if communication concerns exist. Common indicators identified at screenings include speech sound errors, grammar errors, difficulty answering questions/following directions and/or stuttering. Those children identified will be given a more complete assessment to determine if further follow up or treatment is required. This Screening DOES NOT mean that your child will automatically receive a full assessment, or that they will require/receive support from the SLP during their kindergarten year. The following permission form will allow your child to be assessed by a Speech Language Pathologist. If your child is identified as requiring a more detailed assessment, it will be completed. If a need for further services is identified, a referral package will be sent home, to be filled out and returned to your child s teacher. Following the assessment, a full report will be sent to the teacher and then forwarded home. Please sign the form and return in your registration package. If you DO NOT want your child assessed, do not sign the form and please contact your child s teacher. Student s Name Gender Date of Birth Grade AM/PM (Please Print) FIRST SURNAME Y M D M-T-W-Th-Fr School Teacher Father/Guardian Relationship to Student: Living with Student Yes No Address (if different than Student) Home Phone Work Phone Cell Phone Mother/Guardian Relationship to Student: Living with Student Yes No Address (if different than Student) Home Phone Work Phone Cell Phone Signature of parent / guardian: Date: *This signature represents authorization for the Grande Prairie Assessment Team to become involved in assessment, consultation and inservice for the above named student. Thank you, Speech Language Pathology Department, Peace Collaborative Services

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