Send to: WRDSB, Education Centre
Attention: Superintendent, Student Achievement & Well-Being, Re: Home Schooling
51 Ardelt Ave. Kitchener, ON N2C 2R5
Notice of Intent to Provide Home Schooling
I hereby provide the name, gender and date of birth for each child of compulsory school age for
whom I intend to provide Home Schooling: [please print]
(First and Last)
School of Last Record /
Board or N/A *
* Please list last School and Board, if any, that your child attended or N/A if not applicable.
Name of Parent/Guardian:
I wish to notify the Waterloo Region District School Board that I will provide a Home Schooling
for my child(ren) starting in: Month: __________ Year: __________.
I understand it is my responsibility, under the Education Act, to provide satisfactory instruction for
my compulsory school-aged child(ren) and do hereby declare my intent to do so.
Signature of Parent/Guardian:
Signature of Principal:
(required for part-time home schooled students)
Send Completed Form To: WRDSB, Attention: Superintendent, Home Schooling