Fillable Form 2: 2021-2022 REGISTRATION FORM INFORMATION* - Choose

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Form 2: 2021-2022 REGISTRATION FORM INFORMATION* - Choose

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2021-2022 REGISTRATION FORM
Revised: January 2021 Page 1 of 4
Date of Enrolment (month/day/year):
School Attended Last Year (if different):
PROGRAM
INFORMATION* - Choose one of the following
Pre-primary
Integrated French (begins in Grade 7)
English Program
English O
2
(Inquire at high school)
Early French Immersion (begins in Elementary)
French Immersion O
2
(Inquire at high school)
Late French Immersion (begins in Grade 7)
Integrated French O
2
(Inquire at high school)
*Note: Contact school administration for assistance completing this section, if needed.
STUDENT INFORMATION
LEGAL NAME - Must match birth certificate, passport, immigration papers, legal name change certificate, or adoption documents
Last:
First:
Middle:
Preferred first name (the name by which your child will be addressed, and that will appear on school documents):
Date of birth: month _______ day _______ year _______
Proof of identity (must be provided at time of registration):
Adoption documents Birth certificate
Immigration papers Passport
Gender: F (Female) M (Male) X (Non-binary or another gender identity)
Student number (completed by office):
Grade level:
Civic address (Number/apartment, street, community/city/town, province & postal code):
Mailing address (if different from civic address) (Number/apt, street, community/city/town, province & postal code):
Home phone:
Student’s cell phone:
Language Comprehension: English French
Language most often spoken in the home:
Arabic English French Gaelic Mi’kmaw
Other, please specify ______________________________
TECHNOLOGY (In the event of home learning)
Yes
No
Yes
No
Yes
No
Phone or Tablet
Desktop or Laptop
Other
CUSTO
DY ARRANGEMENTS – MUST BE COMPLETED ANNUALLY; appropriate legal documentation shall be provided
Are special custody arrangements requested for this student at school? Yes No
Description/details (include any special instructions):
SCHOOL:
NOTE: You will receive confirmation from your home school upon verification of registration documentation.
Musquodoboit Valley Education Centre
09/02/2021
✔
01
01
2016
✔
✔
Pre-Primary
(902) 555-5555
(902) 555-5555
2021-2022 REGISTRATION FORM
Revised: January 2021 Page 2 of 4
PAR
ENT / GUARDIAN INFORMATION
PARENT/GUARDIAN 1
PARENT/GUARDIAN 2
Name (Last, First):
Name (Last, First):
Relationship:
Relationship:
Civic Address - Complete this section only if different from student’s address
Civic address (Number/apt, street, community/city/town, province &
postal code):
Civic address (Number/apt, street, community/city/town, province &
postal code):
Home phone:
Home phone:
Work phone:
Work phone:
Cell phone:
Cell phone:
Email address:
Email address:
Language comprehension: English French
Language comprehension: English French
Language most often spoken in the home:
Arabic English French Gaelic Mi’kmaw
Other, please specify ______________________________
Language most often spoken in the home:
Arabic English French Gaelic Mi’kmaw
Other, please specify ______________________________
ADDITIONAL EMERGENCY CONTACT(S)
Contact 1
Contact 2
Contact 3
Name (Last, First):
Name (Last, First):
Name (Last, First):
Relationship:
Relationship:
Relationship:
Home phone:
Home phone:
Home phone:
Work phone:
Work phone:
Work phone:
Cell phone:
Cell phone:
Cell phone:
Language comprehension:
English French
Language comprehension:
English French
Language comprehension:
English French
Language most often spoken in the home:
Arabic English French
Gaelic Mi’kmaw
Other, please specify _____________
Language most often spoken in the home:
Arabic English French
Gaelic Mi’kmaw
Other, please specify _____________
Language most often spoken in the home:
Arabic English French
Gaelic Mi’kmaw
Other, please specify _____________
MEDICAL INFORMATION - MUST BE COMPLETED ANNUALLY
Doctor’s name:
Doctor’s phone:
Health Card number:
Health Card expiry date (mm/dd/yyyy):
MedicAlert No. (if applicable):
Health Care Needs/Medical Diagnosis(es)
If YES, please check one or more of the following:
P
lease Note: Checking any of the below requires further program-planning meetings and/or documentation (e.g. Health Plan of Care; Administration
of Medical Forms; etc.)
Anaphylaxis/Life Threatening Allergy(ies) Catheterization
Asthma Diabetes
Seizures Tube Feeding
Administration of prescribed medication is required during the school day.
Diagnosed Mental Illness
Other (please specify): _______________________________________________________________________________
_______________________________________________________________________________
01/01/2021
2021-2022 REGISTRATION FORM
Revised: January 2021 Page 3 of 4
S
IBLINGS
Please list all children in your family who attend school. If you require additional space, please attach a separate page.
Name (Last, First)
Grade
School
TRANSPORTATION
Special Needs Transportation required? Yes No
School Bus Public Bus Pass Walk
AM Bus Route:
PM Bus Route:
AM Stop Location:
PM Stop Location:
AM Bus Driver:
PM Bus Driver:
Eligibility:
Eligible Administration Permission Not
Bus Type:
School Bus Public Bus Pass
Reason for Administration Override:
ALTERNATE BUSSING INFORMATION
Under special circumstances, some children may require alternate pick up and/or drop off locations to/from school and a location other than their
home residence. Within reason, the school will make arrangements to accommodate these requests.
AM PM Both
Street:
Community or City/Town, Province & Postal Code:
Contact Name (Last, First):
Contact Phone:
UNEXPECTED EARLY CLOSURE INSTRUCTIONS
In the event that school must close early, indicate alternative arrangements you want for your child.
INTERNATIONAL/IMMIGRANT STUDENT INFORMATION
Please select one of the following (documentation to verify status in Canada and proof of medical insurance to be provided at time of registration):
Nova Scotia International Student Program (NSISP) Participant:
short term (less than 3 months)
3 months or more
Fee-paying Student (who is not part of the NSISP or an approved exchange program):
has a study permit valid until month ________ day________ year________
is studying for less than 6 months without a study permit
Exchange student (is participating in an exchange through an approved student exchange program)
Permanent resident
Dependant of a temporary resident
parent has a work permit until month ________ day________ year________
parent has a study permit until month ________ day________ year________
Refugee claimant
Citizenship: Medical Insurance: Yes No
01
01
2021
01
01
2021
01
01
2021
2021-2022 REGISTRATION FORM
Revised: January 2021 Page 4 of 4
SELF-IDE
NTIFICATION - Completion of this section is voluntary
Parents/Guardians and/or students are encouraged to self-identify. By doing so, this enables the Department of Education and Early Childhood
Development, Regional Centres for Education and CSAP to have a greater awareness of the diversity of the student population and the communities
served and to better meet the educational needs of students.
INDIGENOUS - For the purpose of this form, Indigenous persons are those who consider themselves to be Mi’kmaw/other First Nations, Métis,
or Inuit.
YES, student is of Indigenous ancestry NO, student is not of Indigenous ancestry
If YES,
to which group do you belong?
Mi’kmaq/other First Nation Métis Inuit
ANCESTRY
Please indicate the ancestry with which the student most identifies. Select all that apply.
Acadian descent African descent (Black) Asian descent East Asian descent
European descent Middle Eastern descent Not listed (NL) above, (please specify)__________________
FRENC
H FIRST LANGUAGE EDUCATION ELIGIBILITY - Completion of this section is voluntary
One of the ways you may access French first language education is under Section 23 of the Canadian Charter of Rights and Freedoms
as an “entitled parent”. Under the Nova Scotia Education Act, children of an entitled parent are entitled to be provided a French-first-
language program. Clause 3(I)(h) of the Act defines “entitled parent” as follows:
An entitled parent means a parent who is a citizen of Canada and
i. whose first language learned and still understood is French, or
ii. who received his or her primary school instruction in Canada in a French-first-language program, or
iii. of whom any child has received or is receiving primary or secondary school instructions in Canada in a French-first-language
program.
As a parent, do you meet at least one of the above criteria? Yes No Do not know
Note:
French first language education is not a French immersion program.
You are advised that future children of your son or daughter may lose their right to an education in the French-first-language if your
child does not attend a French-first-language school.
In Nova Scotia, French first language education is only offered by the Francophone school board, the Conseil scolaire acadien provincial
(CSAP).
Representatives from CSAP are available to answer any questions you have regarding French first language education and to help you
determine if you are an entitled parent.
Do you wish to have your name, home telephone number, and email address given to CSAP for a representative to contact you with
more information about French first language education?
Yes No
You may also contact the CSAP at 902-471-0082, 902-769-5458, 1-888-533-2727, info@csap.ca, or visit the CSAP website at www.csap.ca.
I/we certify that all of the information on this registration form is correct.
X ______________________________________________________________________ Parent/Guardian Signature
______________________________________________________________________ Date
Please email registration form to the home school with digital copies of the following additional required documentation:
- Proof of identity (birth certificate, passport, immigration papers or adoption documents);
- Proof of civic address (utility bill or phone bill);
- Proof of medical insurance
(For international students) - documentation of status in Canada
01/01/2021
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Completed 26 January 2021

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