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: Independent Student Status: [ ] I Declare I am 16 or older and living on my own. School Information (newsletters, attendance etc.): [ ] Yes Callouts to Phone Number [ ] Yes Email: PARENT / GUARDIAN INFORMATION Student lives with: [ ] Mother [ ] Father [ ] Guardian(s) [ ] Self [ ] Other: MOTHER Relation to student: (i.e. stepmother/grandmother, etc.) FATHER Relation to student: (i.e. stepfather/grandfather, etc.) LAST NAME: FIRST NAME: Home Ph: Home Ph: GUARDIAN Relation to student: (i.e. stepmother/grandmother, etc.) LAST NAME: FIRST NAME: GUARDIAN Relation to student: (i.e. stepmother/grandmother, etc.) Home Ph: Home Ph: 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: OFFICE USE Section # Teacher name: 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 v4.4 Page 1 French Immersion [ ] Regular [ ] Late Entry Course Funding: [ ] Self [ ] Worker s Comp [ ] Youth Connections [ ] Human Resources [ ] Worker s Comp [ ] Band [ ] CFSA (office) [ ] Other
MEDICAL / EMERGENCY INFORMATION EMERGENCY CONTACT #1 (Other than parents) EMERGENCY CONTACT #2 (Other than parents) Relation to student: (i.e. stepmother/grandfather, etc.) Home Ph: Relation to student: (i.e. stepfather/grandfather, etc.) Home Ph: 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 has had that the school should know about STUDENT S CITIZENSHIP STATUS STUDENT S ABORIGINAL STATUS [ ] Canadian Citizen (Copy of Birth Certificate or Canadian Passport Required) If you wish to declare that you are an Aboriginal Person, please specify: [ ] Permanent Resident (Copy of Birth Certificate &Canadian Permanent Resident Card Required) [ ] Status Indian/ First Nations - a person who is registered as an Indian [ ] Temporary Resident under the Indian Act (Copy of Birth Certificate & Canadian Immigration Papers / Student Visa Required) [ ] Non-Status Indian/ First Nations An Indian person who is NOT registered [ ] Child of Canadian Citizen as an Indian under the Indian Act. (Copy of Birth Certificate & Copy of Canadian Parent s Birth Certificate Required) [ ] Metis People of mixed First Nation and European ancestry who identify [ ] Other (Please explain): themselves as distinct from First Nations people, Inuit, / non-aboriginal people [ ] Inuit an Aboriginal Alberta Education is collecting this personal information pursuant to Section 33(c) of the FOIPP 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, program, and services to ENGLISH AS A SECOND LANGUAGE improve Aboriginal learner success. For further information, or if you have questions regarding Is English the student s first language spoken at home? [ ] Yes [ ] No the collection activity, please contact the office of the Director, Aboriginal Policy, Policy Sector, Information and Strategic Services Division, Alberta Education, 7th Floor Commerce Place, If NO, what is the first language spoken at home: 10155 102 Street, Edmonton, AB T5J 4L5, Phone 780-427-8501. You may also wish to contact the Grande Prairie Public School District FNMI Coordinator by telephoning the District Office at 780-532-4491. 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 v4.4 Page 2
Form 180-1 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. 2357 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 District 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 780-532-4491. Grande Prairie Public School District #2357 September 2013 Forms Directory
9351-116 Avenue Grande Prairie, AB T8V 6L5 (780) 539-0333 FAX (780) 539-7613 Dear Parents, In the fall, all children in kindergarten will be screened by a member of the SLP department to determine if 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 the Speech Language Pathologist to screen and assess your child. If your child is identified as requiring further service, it will be completed and a referral package will be sent home, to be filled out and returned to your child s teacher. Following the assessment, a full report, including a treatment plan, will be sent 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 Peace Collaborative Services to become involved in assessment, consultation and in-service for the above named student. Thank you, Speech Language Pathology Department
KINDERGARTEN IMMUNIZATION Dear Parent/Guardian: As part of your child s entry into Kindergarten, an appointment at the Public Health Centre for preschool immunization and discussion of your child s health is recommended. During this time, the Public Health Nurse will discuss any concerns you may have regarding your child s health and give the immunization booster for DTaP-IPV (Diphtheria, Tetanus, Whooping Cough and Polio), MMR (Measles, Mumps and German Measles) and Varicella (Chicken Pox), if necessary. Please call the local Public Health Centre at 780-513-7500 to book an appointment for your child s preschool booster. If you are new to the community, please ask the Public Health Centre staff to request your child s records from your former Public Health Centre. Please fill out the following information and the Public Health Services New Student Information which is attached. Child s Name: Parent(s) Name: Home or Cell Phone Number for Parents: Immunizations can protect your child s health and future. Please check one of the following My child s immunizations are up to date. My child is overdue for his/her preschool immunizations. Public Health Nurse Alberta Health Services
Grande Prairie Public School District #2357 10213-99 Street Grande Prairie, AB T8V 2H3 Phone: 780.532.4491 Fax: 780.539.4265 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 emails, 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 780-532-4491. 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).