SIMCOE MUSKOKA CATHOLIC DISTRICT SCHOOL BOARD STUDENT REGISTRATION and INFORMATION. School Student Enrolling At:

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1 SICOE USKOKA CAHOLIC DISRIC SCHOOL BOARD SUDEN REGISRAION and INORAION School Student Enrolling At: ransportation Department, as necessary. Parents/guardians/adult students need to inform the school of any changes in this information. his personal information is being collected and will be maintained in keeping with reedom of Information and Privacy legislation. It may be accessed by the student and the parent/guardian of a student under 18 years of age, as well as by SUDEN INORAION SCHOOL USE ONLY ENRY CODE #: PROVINCIAL OEN #: Legal : Usual : Legal : Preferred : Legal iddle Name: Date of Birth: Gender: ale emale Student Number: (if left blank, the system will assign the student number) Home Ph #: Unlisted Yes No Enrolment Date: or Grade: Admission Status: ADDRESS Home Address: _ Street # /911# Street Name Apt # _ City/own/unicipality ailing Address: Name of ownship Same as Home Address Postal Code RR # PO Box Conc/Comp Lot/Site City/own/unicipality Postal Code ransportation Address: Same as Home Address RR # PO Box Conc/Comp Lot/Site _ City/own/unicipality *Proof of Birth: Postal Code Other: *Proof of Address: (e.g. purchase/lease agreement, utility bill, etc.)

2 PREVIOUS SCHOOL INORAION Previous School Board: Previous School: Address: Last Day of Attendance: If outside of province, please indicate province or country and language of instruction: CIIZENSHIP INORAION Canadian Citizenship (Child born in Canada): City of Birth: Province: Student s irst : Primary Spoken at Home: Permanent Resident: Date became a permanent resident: irst Nation, étis and Inuit Students: Please check as applicable: irst Nation or more information please see our étis website Inuit Refugee Status Expiry date: Study Permit for Visa Student: (Visitor Record) Study Permit valid from: to Parent s ork Permit or Study Permit: Study Permit valid from: to Letter of Approval from Superintendent Supporting Documents Student s Study Permit: Permit expiry date: ees Paid NOE: HIS SUDY PERI IS GIVEN O A CHILD ACCOPANYING A PAREN HERE ON A ORK PERI. SUDY PERI NO REQUIRED OR SUDEN I PAREN IS ON A SUDY PERI. Exchange Student: Attending host school Agency: to Other: Diplomat Status/inister s Permit/ Visitor s Record **PLEASE CONIR IH HE SUPERINENDEN S OICE, HE REQUIRED DOCUENAION & APPLICABLE EES. If student is not born in Canada please indicate the following: Country of Birth: Citizen of: Original Date of irst Entry into Canada Date of Entry Stamp as indicated. his personal information will be maintained in keeping with reedom of Information and Privacy Legislation. Parent/Guardian/Custodian: Name: Relationship to Student: Signature: Date: Principal: Name: Name: Date: Date: Signature: Signature:

3 EDICAL INORAION Doctor s Name: Phone: Health Card # Dentist s Name: Phone: Allergies & edical Conditions: Life hreatening: Yes No (Allergy or edical Condition) Life hreatening: Yes No (Allergy or edical Condition) Name of edication(s): *Copy of Immunization Card submitted Epi Pen Required: Yes No PAREN / GUARDIAN INORAION Custody Information: Both Parents other Only ather Only Shared Joint Guardian C.A.S. Living ith: Both Parents other Only ather Only Guardian Other C.A.S. Community Agency Support: (If Applicable) Agency Name Contact orker Phone (area code & ext) other: Catholic Living ith Correspondence Access Denied Legal Guardian Legal Custody ather: Catholic Living ith Correspondence Access Denied Legal Guardian Legal Custody Step-other: _ Catholic Living ith Correspondence Access Denied Legal Guardian Legal Custody Step-ather: Catholic Living ith Correspondence Access Denied Legal Guardian Legal Custody

4 EERGENCY INORAION Other Emergency Contact: Relationship to Student Permission to pick up child? Yes No Other Emergency Contact: Relationship to Student Permission to pick up child? Yes No Day Care Name of Day Care Contact Name Address Information: Phone Number Permission to pick up child? Yes No SACRAENAL INORAION Student is Catholic: Yes No Parish: Priest: Baptismal Parish: Date: irst Communion Parish: Date: Confirmation Parish: Date: SCHOOL USE ONLY: Busing Information ROUE # SOP YPE IE DAYS O EEK SOP DESCRIPION SIBLING INORAION If student has brothers or sisters in this school, please indicate below. (s), (s)

5 SPECIAL EDUCAION Yes No Has student received Special Education support in a regular or separate classroom? If yes, please explain. Yes No Has student received a diagnosis? If yes, please explain. Yes No process? If Yes, designation? Yes No Does the student have personalized equipment funded by the school board? (e.g. computer, system). Please describe. *(If possible please provide school with a copy of the latest IPRC & Individual Education Plan) RELEASE O INORAION I hereby release the above information to the Simcoe uskoka Catholic District School Board for the uses noted. In addition, I certify that I am the parent or legal guardian of the above student, or that I am an adult student 18 years of age or older, and the information is correct. contact, etc.), I hereby consent to have the Principal release necessary information, such as names and telephone numbers given above, to anyone directly involved in that system. academic programming. Name of Parent/Guardian (please print) Signature of Parent/Guardian OR BOARD OICE PURPOSES REGARDING DIRECION O SUPPOR Is either parent baptized Roman Catholic? Yes No Is the student baptized Roman Catholic? Yes No ax Support: Separate Public ***Provincial Legislation states that only individuals baptized Roman Catholic have the right to direct their taxes to the Separate School system.*** Direction of ax Support and/or Roman Catholic Separate School Support Lease has been completed. Note: Direction of support cannot be split between the Catholic school board and the public school board.

6 REQUIRED DOCUENAION CHECKLIS REGISERING OR ELEENARY SCHOOL REQUIRED DOCUENAION CHECKLIS REGISERING OR SECONDARY SCHOOL CANADIAN BORN SUDENS CANADIAN BORN SUDENS Registering for elementary school Registering for secondary school Report Card from last school attended (Copy in OSR) ranscript (Copy in OSR) Attendance Record Latest unicipal ax Assessment (PAC)/ax Bill (Copy in OSR) Completed Application for Direction of School Support orm and/or School Support lease (orwarded to Planning Dept) Proof of Address (Copy in OSR) Recent IPRC & IEP assessments (if applicable) Child s Immunization Card (Copy in OSR) (Copy in OSR) (Copy in OSR) Child s Immunization Card (Copy in OSR) Latest unicipal ax Assessment (PAC)/ax Bill (Copy in OSR) Completed Application for Direction of School Support orm and/or School Support Lease (orwarded to Planning Dept) Proof of Address (Copy in OSR) Recent IPRC & IEP assessments (if applicable) Canada must remain in the OSR. SUDENS NO BORN IN CANADA Registering for elementary school Canada must remain in the OSR. SUDENS NO BORN IN CANADA picture and Visa) (Do Not Copy) Documentation indicating Immigration Status in Canada may include one of the following: Canadian Citizenship Card Residency Paper or Permanent Residence Application with receipt Study Permit ork Permit I 1442 Refugee documentation inister s Permit to Come Into/Remain in Canada Record of Landing (I5292 or 1000) Other (please specify) Other Required Documentation for Visa Students: Superintendent s Approval Letter Notarized Guardianship Agreement Valid from to Registering for secondary school Report Card from last school attended (Copy in OSR) ranscript (Copy in OSR) Child s Immunization orm (Copy in OSR) Latest unicipal ax Assessment (PAC)/ax Bill (Copy in OSR) Proof of Address (Copy in OSR) Completed Application for Direction of School Support orm and/or School Support Lease (orwarded to Planning Dept) picture and Visa) (Do Not Copy) Documentation indicating Immigration Status in Canada may include one of the following: Canadian Citizenship Card Residency Paper or Permanent Residence Application with receipt Study Permit ork Permit I 1442 Refugee documentation inister s Permit to Come Into/Remain in Canada Record of Landing (I5292 or 1000) Other (please specify) Other Required Documentation for Visa Students: Superintendent s Approval Letter Notarized Guardianship Agreement Valid from to **Please ensure that you have adequate health/medical coverage. **Please ensure that you have adequate health/medical coverage. Child s Immunization Card (Copy in OSR) Latest unicipal ax Assessment (PAC)/ax Bill (Copy in OSR) Proof of Address (Copy in OSR) Completed Application for Direction of School Support orm and/or School Support Lease (orwarded to Planning Dept)