Fillable Student Registration Form

Fill Online, Printable, Fillable, Blank Student Registration Form Form

Use Fill to complete blank online OTHERS (CANADA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Student Registration Form

On average this form takes 80 minutes to complete

The Student Registration Form form is 4 pages long and contains:

  • 0 signatures
  • 132 check-boxes
  • 260 other fields

Country of origin: CANADA
File type: PDF

BROWSE OTHERS (CANADA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
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
Grade
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
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Student Registration Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 23 November 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document