Fillable REGISTRATION INSTRUCTIONS Contact your most recent school to (Gary Allan Learning Centre)

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REGISTRATION INSTRUCTIONS Contact your most recent school to (Gary Allan Learning Centre)

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REGISTRATION INSTRUCTIONS
DOWNLOAD AND SAVE THIS FORM TO YOUR COMPUTER WITH A NEW FILE NAME PRIOR TO COMPLETION.
• Contact your most recent school to obtain a copy of your High School Transcript
• Collect each of the following FOUR Proof of Identity documents:
1 Proof of Citizenship
1 Proof of Date of Birth
2 documents showing Proof of Ontario Residency.
See all acceptable documents here. No other documents will be accepted.
• Complete the registration package in FULL
• Email the completed registration package, your transcript, and all Proof of Identity documents
to ConEd@hdsb.ca
Once all documents are received, you will be contacted with more information. If you have
indicated on your registration form that you wish to speak with a Counselor to discuss an
education plan, we will contact you to schedule an appointment.
Please allow 2 to 4 business days to process your registration.
Applications with missing or unclear documentation will not be processed.
2021-2022 SCHOOL YEAR
Student Name: _____________________________________________
School Name: ______________________________________________
Student OEN (Ontario Education Number): _ _ _ _ _ _ _ _ _
S
S
T
T
U
U
D
D
E
E
N
N
T
T
R
R
E
E
G
G
I
I
S
S
T
T
R
R
A
A
T
T
I
I
O
O
N
N
F
F
O
O
R
R
M
M
(PLEASE PRINT)
STUDENT INFORMATION:
Last Name _____________________ First Name ___________________ Middle Name ________________
(Legal) (Legal) (Legal)
Last Name _____________________ First Name ___________________ Middle Name ________________
(Preferred) (Preferred) (Preferred)
Date of Birth _ _ _ _ / _ _ / _ _ Male Female Self-Identify as _______________
Year Month Day
Has the student ever been registered at a school within the Halton District School Board?
Yes
No
If Yes, provide the name of the school within the Halton DSB most recently attended:
_______________________________________________________________________ Last grade attended _________
Has the student ever been registered at a school within the Province of Ontario? Yes No
If Yes, provide the name of the school most recently attended:
If No, provide the name of the school most recently attended outside of Ontario:
_______________________________________________________________________ Last grade attended _________
School Address: _____________________________ School Phone Number: (_ _ _) _ _ _ - _ _ _ _
_____________________________ School Fax Number: (_ _ _) _ _ _ - _ _ _ _
_____________________________ School E-mail: ____________________________
Name of School Board: ____________________________________________________________________________
Is the student
currently
suspended from school? Yes
No
Is the student currently expelled from a school or board? Yes No
Has the student ever been previously suspended/expelled from a school or board? Yes
No
SPECIAL EDUCATION:
Has the student ever been identified through an IPRC and/or received special education support? Yes No
Date of Birth Verification: Birth Certificate
Canadian Citizenship
Immigration Papers
Passport
Other
Optional Attendance Yes No
Proof of Canadian Citizenship Yes No
Proof of Permanent Residency Yes
No
(Parents)
Proof of Address Yes No
International Student Yes No
Student No.
Tr
illium Entry Date
Track
Date of Entry
Prior ESL/ELD Instruction?
Program
Home Form
Tax Support Public Board
Yes
No
If no, please contact www.voterlookup.ca or call 1-866-296-6722 to register.
Shaded Areas for Office Use Only
Yes No
SIBLING INFORMATION: (if the student has brothers or sisters in this school, please indicate)
Last Name First Name
1)
2)
3)
MEDICAL INFORMATION:
Medical Conditions:
If your child has prevalent medical conditions of which the school should be aware, please indicate the condition(s) below.
Anaphylaxis – please indicate allergen(s): _______________________________________________________________
Asthma Diabetes Epilepsy/Seizures
If your child has been diagnosed with any other medical condition, please identify: Life Threatening
__________________________________________________________________ Yes No
__________________________________________________________________ Yes No
__________________________________________________________________ Yes No
Fill in the section below, ONLY if country of birth is other than Canada. Legal Documents are required.
Birth Country ____________ Arrival Date in Canada _________ _________ Arrival Date in Ontario ______________
Status in Canada ______________________________ Verification _________________________________________
Expiry Date _________________________________Country of Last Residence _______________________________
PRIMARY STUDENT HOME ADDRESS Proof of Address Required
This information will be shared with Halton Student Transportation Services for the provision of home to school transportation.
Number ________ Street _______________________________________________________________
Apt. No. ________________ Unit No. _____________________ Suite No. __________________
City/Town ________________________ Province _____________ Postal Code ________________
STUDENT HOME PHONE NUMBER:
__ __ __ - __ __ __ - __ __ __ __ Unlisted
Student Cell Phone No. __ __ __ - __ __ __ - __ __ __ __ E-mail Address_____________________________________
MAILING ADDRESS:
(if different from home address)
Number ________ Street _______________________________________________________________
Apt. No. ________________ Unit No. _____________________ Suite No. __________________
Rural Route No. __________ Post Office Box No. ____________ General Delivery No. ________
City/Town ________________________ Province _____________ Postal Code ________________
ABORIGINAL STUDENT SELF-IDENTIFICATION: (please check off one of the boxes below, this is voluntary)
Metis AncestryFirst Nation Ancestry Inuit Ancestry
Country of Citizenship to be completed for ALL students:
Country of Citizenship___________________________________ Province of Birth ___________________________
(If born in Canada)
Languages Spoken (if other than English)
1) ____________________________ First Language Spoken at Home Main Language at Home
2) ____________________________ First Language Spoken at Home Main Language at Home
PARENT / GUARDIAN INFORMATION ONLY
1) Last Name _________________
________________________________ First Name ______________________________
Contact priority should be based on whom to call in the case of an emergency and/or school closure. (Check 1 = high, 4 = low)
For Emergency: Priority 1 2 3 4 For School Closure: Priority 1 2 3 4
(Please check ALL applicable boxes.) Male Female Self-Identify as ____________
Relationship
Mother Access to Student Guardian Lives with Student Access to Records
Father No Access Custody Receives Mail Speaks School Language
Stepparent
Parent
Foster Parent
Legal Guardian
Home No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3 Cell. No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3
Business No.
_ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _ Priority 1 2 3 Place of Employment : ________________________
E-mail Address: _________________________________ If e-mail address is provided, it may be used for communication purposes.
Home Address (complete only if different from student)
No. ______ Street ___________________________ Apt. No. _____ Unit No. ______ Suite No. _____
R.R. # ___ P.O. Box ________ Gen. Del. # _______ City/Town ____________ Prov. _____ Postal Code_______
2) Last Name _________________________________________________ First Name _______________________________
Contact priority should be based on whom to call in the case of an emergency and/or school closure. (Check 1 = high, 4 = low)
For Emergency: Priority 1 2 3 4 For School Closure: Priority 1 2 3 4
(Please check ALL applicable boxes.) Male Female Self-Identify as ____________
Relationship
Mother Access to Student Guardian Lives with Student Access to Records
Father No Access Custody Receives Mail Speaks School Language
Stepparent
Parent
Foster Parent
Legal Guardian
Home No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3 Cell. No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3
Business No.
_ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _ Priority 1 2 3 Place of Employment : ________________________
E-mail Address: _________________________________ If e-mail address is provided, it may be used for communication purposes.
Home Address (complete only if different from student)
No. ______ Street ___________________________ Apt. No. _____ Unit No. ______ Suite No. _____
R.R. # ___ P.O. Box ________ Gen. Del. # _______ City/Town ____________ Prov. _____ Postal Code_______
3) Last Name _________________
________________________________ First Name ______________________________
Contact priority should be based on whom to call in the case of an emergency and/or school closure. (Check 1 = high, 4 = low)
For Emergency: Priority 1 2 3 4 For School Closure: Priority 1 2 3 4
(Please check ALL applicable boxes.) Male Female Self-Identify as ____________
Relationship
Mother Access to Student Guardian Lives with Student Access to Records
Father No Access Custody Receives Mail Speaks School Language
Stepparent
Parent
Foster Parent
Legal Guardian
Home No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3 Cell. No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3
Business No.
_ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _ Priority 1 2 3 Place of Employment : ________________________
E-mail Address: _________________________________ If e-mail address is provided, it may be used for communication purposes.
Home Address (complete only if different from student)
No. ______ Street ___________________________ Apt. No. _____ Unit No. ______ Suite No. _____
R.R. # ___ P.O. Box ________ Gen. Del. # _______ City/Town ____________ Prov. _____ Postal Code_______
If No Access, legal documentation required.
Documentation Received: Yes No
If No Access, legal documentation required.
Documentation Received: Yes
No
If No Access, legal documentation required.
Documentation Received: Yes
No
Personal information is collected on this form in compliance with the Municipal Freedom of Information and Protection
of Privacy Act, R.S.O. 1990, c. M56, and is collected under the authority of the Education Act, R.S.O. 1990, c. E.2.
Personal information will be used for purposes related to the regular operational requirements of the educational and
administrative functions of the Halton District School Board. For additional information about how the HDSB uses
personal information please see the HDSB Statement of Personal Information Practices or, contact your school Principal.
I cer
tify that the information provided on this form is accurate.
Parent/Guardian Signature: ____________________________________ Date: _______________________
(or student if 18 years of age or older)
Administrator/Designate Signature: _____________________________ Date: _______________________
Revised November 2019
ADDITIONAL STUDENT INFORMATION:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
If parent/guardian cannot be contacted during the day, contact this person.
1) Last Name __________________________________________ First Name _______________________________
Male Female Self-Identify as ____________ Relationship to student/comment: ____________________
Home No
. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3 Cell. No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3
Business No. _ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _ Priority 1 2 3
If par
ent/guardian not available, contact this person.
2)
Last Name __________________________________________ First Name _______________________________
Male Female Self-Identify as ____________ Relationship to student/comment: ____________________
Home No
. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3 Cell. No. _ _ _ - _ _ _ - _ _ _ _ Priority 1 2 3
Business No. _ _ _ - _ _ _ - _ _ _ _ ext. _ _ _ _ Priority 1 2 3
FOR SECONDARY SCHOOL USE ONLY:
(To be c
ompleted for students entering Secondary School on or after September 1999)
Previ
ous Community Service Hours completed outside Halton DSB: _______ hours
Grade 1
0 Literacy Test successfully completed
(Please provide proof of results) Yes No
EMERGENCY CONTACT INFORMATION
Proof of Literacy Test Results Received: Yes No
Authorization for use 
of Student Photos/Videos and
other Personal Identifying Information
Please read the information below and indicate which option you deem appropriate for your child.
This form will take effect for the remainder of the current 2020/2021 school year.
The Halton District School Board (HDSB) is asking parents/guardians for written authorization regarding
the use of student work, photographs, videos, and other personal identifying information that may be
shared publicly.
During the school year, it is the practice of the HDSB to publicize many of the positive activities that occur
in schools. Your child may be involved in a school activity where photographs or video may be taken for
system informational purposes, such as event or school promotion, school or Board website content,
social media posts, media coverage, or for future use in teacher workshops.
Photos/videos, and other personal identifying information will not be used in any commercial fashion or
without the permission of the school/HDSB. Should parent/guardian circumstances change during the
school year, or should parents/guardians wish to revoke their consent, a written statement revoking
consent must be provided to the school.
Note: It is the practice of the HDSB to use first names only when identifying elementary students
in photographs/videos on school or Board websites and social media platforms.
Student: _____________________________________________________________ Homeroom: _______________
Teacher: _____________________________________________________________ Grade: _____________________
Parent/Guardian Name(s): _________________________________________________________________________
Parent/Guardian Signature(s): ________________________________ Date: ______________________
Please indicate your consent below, sign and return this form to the school. Choose one of the
following:
❏
Yes
By indicating “Yes” above, I
give consent to the following
examples:
❏
Yes, but no posting on
website or social media.
By indicating “Yes” above, I
agree to the following
examples:
❏
No
By indicating “No” above, I
agree to the following
examples:
Displaying my child’s
work/photos/videos on bulletin
boards, multimedia work, school
newsletters, yearbooks
Displaying my child’s
work/photos/videos on bulletin
boards, multimedia work, school
newsletters, yearbooks
Do not display my child’s
work/photos/videos on bulletin
boards, multimedia work, school
newsletters, or yearbooks
PA announcements to share my
child’s birthday or their
participation in school events
PA announcements to share my
child’s birthday or their
participation in school events
Do not make PA
announcements to share my
child’s birthday or participation
in school events
See Page 2...
Photos/videos of my child in
classroom/school-wide activities
(e.g., school plays, concerts,
special events, school trips,
assemblies, graduation)
Photos/videos of my child in
classroom/school wide activities
(e.g., school plays, concerts,
special events, school trips,
assemblies, graduation)
Do not share photos/video of
my child in classroom/school
wide activities (e.g., school plays,
concerts, special events, school
trips, assemblies, graduation)
Posting lists with my child’s
name inside the school about
class, clubs or team
organizations
Posting lists with my child’s
name inside the school about
class, clubs or team
organizations
Do not post my child’s name on
a list of student names inside the
school about class, clubs or team
organizations
Photos/videos of my child on
school/HDSB websites
Do not postphotos/videos of
my child on school/HDSB
websites
Do not post photos/videos of
my child on school/HDSB
websites
Photos/videos of my child on
school/HDSB social media
platforms (Twitter, Facebook,
YouTube, Instagram, etc.)
Do not postphotos/videos of
my child on school/HDSB social
media platforms (Twitter,
Facebook, YouTube, Instagram,
etc.) 
Do not post photos/videos of
my child on school/HDSB social
media platforms (Twitter,
Facebook, YouTube, Instagram,
etc.) 
Revised: May 2020
Complete this Check list before submitting your application.
In order to register for any HDSB programs, the following documentation must be submitted at time of
registration: Proof of Citizenship, Proof of Date of Birth, AND Proof of Ontario Residency.
NO OTHER FORMS of documentation will be accepted.
Please indicate which form of Proof of Citizenship you have attached.
Select ONE of the following:
Birth Certificate
Immigration Papers
Permanent Resident Card
Passport
Canadian Citizenship Documents
Refugee Documents
Please indicate which form of Proof of Date of Birth you have attached.
Select ONE of the following:
Birth Certificate
Immigration Papers
Baptismal/Faith Record
Passport
Canadian Citizenship Documents
Please indicate which form of Proof of Ontario Residency you have attached.
Select TWO of the following:
Current Lease or Deed
Current Property
Tax Bill
Current Home Utility Bill
Current Motor Vehicle
Ownership
Original Credit
Card Statement
Current bank statement
Recent correspondence from a Municipal,
Federal or Provincial Government Agency
Most recent original Income Tax Assessment
Note: Driver’s license/Health Card are not acceptable, as in some cases you may hold an Ontario
Drivers licence/Health card and no longer permanently reside in Ontario
Ensure that all documents are clear and legible. If submitting photos of documents, the photo must
be taken straight-on, be in focus, and have no glare.
I confirm that I have attached the FOUR required documents as listed above
I confirm that I have downloaded and saved this registration form to my computer prior to completion
and filled it out entirety
Applications with missing or unclear documentation will not be processed.
Email completed registration form and all required documents to ConEd@hdsb.ca
Once all documents are received and processed, you will be contacted with more information.
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REGISTRATION INSTRUCTIONS Contact your most recent school to (Gary Allan Learning Centre)

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Completed 17 July 2021

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