page 1 of 4
Home Schooling Registration Form
2021–2022 School Year
Student Information
Surname: Given name(s):
Grade: Date of birth:
Gender: Male Female X (Non-binary or another gender identity)
Street address/PO box:
City/Town: Postal code:
Most Recent Public/Private School Experience
Date last attended: Grade: School:
Is this student currently registered for home schooling in Nova Scotia? yes no
If no, has the student been previously registered? yes no If yes, which year(s)?
Do you have other children who are or have been registered for home schooling in Nova Scotia? yes no
If yes, please give their names:
Parent/Guardian Information
PARENT/GUARDIAN 1 PARENT/GUARDIAN 2
Name (Last, First): Name (Last, First):
Relationship: Relationship:
Civic Address: Civic Address:
Home phone: Home phone:
Work phone: Work phone:
Cell phone: Cell phone:
Email address: Email address:
CUSTODY 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):
Parent/Guardian Declaration
I certify that I have familiarized myself with sections 83–84 of the Education Act and sections 31–34 of the Governor in
Council Education Act Regulations (available at www.ednet.ns.ca/homeschooling/legislation-and-regulations), which
outline the responsibilities associated with home schooling in Nova Scotia.
I therefore declare to the Department of Education and Early Childhood Development my intention to home school my
child as stated in this form.
Parent/guardian signature: Date:
Your privacy is important to us. For details on how we protect your information, please visit www.ednet.ns.ca/homeschooling/questions-answers.
Education and
Early Childhood Development
dd mm
yyyy
click to sign
signature
click to edit
![]()
