Fillable Student Registration Form (Peel Schools)

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Student Registration Form (Peel Schools)

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Parent Registration Checklist
In all instances, ORIGINAL documentation or officially certified true copies must be presented.
Student Currently Registered with the Peel District School Board ~ Required:
Transfer form (Elementary) or Status Sheet (Secondary) from previous Peel District School Board school
Proof of Address (see list below)
Completed Registration Form
Student Not Currently Registered with the Peel District School Board ~ Required:
Proof of child's age and citizenship/eligibility (present one original document from the list below)
Canadian Birth Certificate/Birth Registration Card
Canadian Citizenship Card / Certificate / Passport
Permanent Resident Card / Confirmation of Permanent Residence
Work permit/Employment Authorization from Citizenship and Immigration Canada
Study Permit issued to parent for a diploma or degree program from Citizenship and Immigration
Canada
Refugee/Convention Refugee Permit
Visitor Permit for Missionary Work (only case type 13)
Proof of address (present one original document from the list below)
Utility Bill (water, hydro, gas, phone, cable, cell phone)
Bank Statement/Letter from Financial Institution
Credit Card Statement
Government forms (i.e. Service Canada, Ontario Works or Canada Post change of address)
Purchase Agreement
Other Government Identification (e.g. Ontario Photo Card)
Please note that a driver’s license cannot be accepted.
Proof of immunization
Students registering in an Ontario public school for the first time must provide proof of
immunization/vaccination or valid Exemption from Peel Health. Parents are encouraged to report
your child’s immunization online at www.peelregion.ca/immunize and provide the reference number
to your child's school on the student registration form.
Students with an Ontario Education Number (shown on Ontario report cards or transcripts) do not
need to provide proof of immunization
Proof of custody – children must live with their parent(s) unless provided documentation supports an
alternate living arrangement
Proof of education
For Elementary students who are currently attending school in Ontario, please bring the most re-
cent report card
For Secondary students who are attending or have attended secondary school in Ontario, please
bring the most recent transcript, report card or credit summary report (if available)
Notify school at time of registration if your child is registered currently in a specialized program such
as SHSM (include sector), IB, IBT, FI, EF, ELL or other programming
Provide a copy of your child’s most recent IEP, if applicable.
Completed Registration Form
1
January 2020
S T U D E N T I N F O R M A T I O N
R E S I D E N T I A L A D D R E S S
M A I L I N G A D D R E S S
G E N E R A L S T U D E N T I N F O R M A T I O N ( M u s t b e c o m p l e t e d i n f u l l )
H E A L T H F A C T O R S ( M u s t b e c o m p l e t e d i n f u l l )
STUDENT NUMBER (If Transfer)
ONTARIO EDUCATION NUMBER (OEN) GRADE/HOME FORM ADMISSION DATE (yyyy-mm-dd)
GR 9 ENTRY DATE (yyyy-mm-dd)
LEGAL LAST NAME
LEGAL FIRST NAME MIDDLE NAME
GENDER
MALE
USUAL LAST NAME
PREFERRED FIRST NAME BIRTH DATE (yyyy-mm-dd)
FEMALE
OTHER
HOME PHONE NUMBER
( )
UNLISTED
YES
APT. NO. STREET/EMERGENCY NUMBER STREET NAME/LINE OR SIDE ROAD
P.O. BOX TOWN/CITY PROVINCE
POSTAL CODE
IF DIFFERENT THAN
RESIDENTIAL ADDESSS
APT. NO.
STREET NUMBER STREET NAME/LINE OR SIDE ROAD
P.O. BOX TOWN/CITY
POSTAL CODE
PREVIOUS SCHOOL DISTRICT PREVIOUS SCHOOL NAME PREVIOUS SCHOOL ADDRESS
PROOF OF AGE & NAME (copy for OSR)
CDN. BIRTH CERTIFICATE/
REGISTRATION CARD
CDN. PASSPORT
CANADIAN CITIZENSHIP CARD
PERMANENT RESIDENT CARD/FORM
OTHER IMMIGRATION DOC _________________________
FOR FUNDING PURPOSES ONLY
Country of Birth Province/Territory 1
st
Entry Date into
If Canada Canada (yyyy-mm-dd)
______________________ ______________________ ________________________
WAS ENGLISH FIRST LANGUAGE STUDENT
LEARNED AT HOME? YES NO
LANGUAGES STUDENT SPEAKS AT HOME ___________________________ __________________________ __________________________
VOLUNTARY AND CONFIDENTIAL SELF-IDENTIFICATION FOR FIRST NATION, MÉTIS, AND INUIT STUDENTS FIRST NATION MẾTIS INUIT
HEALTH FACTORS
ASTHMA - Life Threatening YES NO
SEIZURES - Life Threatening YES NO
DIABETES - Life Threatening YES NO
ALLERGIES ___________________________________ Life Threatening YES NO
OTHER _______________________________________ Life Threatening YES NO
Medicaon Required at School? YES NO (If yes, Medicaon Form must be completed)
Immunizaon Required:
Peel Health Immunizaon Reference #
PEEL- __ __ __ __ __ __ __ __ __
(9 alphanumeric digits)
OR Peel Health Exempon #
PEEL- __ __ __ __ __ __ __
(7 alphanumeric digits)
S T U D E N T REGI S T R A T I O N F O R M
S H A D E D A R E A S F O R S C H O O L U S E O N L Y
CUSTODY
BOTH PARENTS
*Documents Required
*FATHER ONLY
*SELF (16 & OVER)
LIVING WITH
BOTH PARENTS
FATHER ONLY
SELF
*MOTHER ONLY *LEGAL GUARDIAN(S) *CHILDREN’S AID SOCIETY
MOTHER ONLY LEGAL GUARDIAN(S) FOSTER PARENT(S)
MOTHER GUARDIAN
FATHER SELF
Last Name First Name Speaks English
YES NO
Home Phone Number
( )
Cellular Number
( )
Business Phone Number (including Ext.)
( )
E-mail Address*
MOTHER GUARDIAN
FATHER SELF
Last Name First Name Speaks English
YES NO
Home Phone Number
( )
Cellular Number
( )
Business Phone Number (including Ext.)
( )
E-mail Address*
Address if different from student (include street number, name, city and postal code)
If parent is deceased:
Parent: Date of Death ___________________________________________ Parent: Date of Death ___________________________________________
2
S I B L I N G I N F O R M A T I O N ( M u s t b e c o m p l e t e d i n f u l l )
E M E R G E N C Y C O N T A C T S I F P A R E N T ( S ) / G U A R D I A N ( S ) U N A V A I L A B L E — I N O R D E R O F A V A I L A B I L I T Y ( # 1 E A S I E S T T O C O N T A C T )
*CONSENT TO RECEIVE ELECTRONIC COMMUNICATION FROM THE PEEL DISTRICT SCHOOL BOARD
I hereby consent to receive electronic communicaon from the Peel District School Board at the email address I have provided. I understand this consent will be
eecve for the duraon of my child’s educaon at the board. I understand this informaon may be shared with the School Council (co-)chair(s) for my child’s
schools for the purposes of sending School Council informaon to me via email.
You may withdraw your consent and unsubscribe from our communicaons at any me by clicking the unsubscribe link in any future email, or by contacng your
child’s school or the board oce at 905-890-1010.
I CONFIRM THAT OUR FAMILY IS A PUBLIC SCHOOL SUPPORTER.
YES NO If no, reason. ________________________________________________________________
IF THE CHILD IS NOT A PEEL DISTRICT SCHOOL BOARD STUDENT, I AGREE THAT THE PEEL DISTRICT SCHOOL BOARD MAY CONTACT MY CHILD'S FORMER SCHOOL TO
COLLECT INFORMATION FOR PURPOSES CONSISTENT WITH THE BOARD'S LEGISLATED RESPONSIBILITIES AND AUTHORITY.
YES NO If no, reason. _______________________________________________________________
IS THE STUDENT CURRENTLY SERVING A SUSPENSION OR EXPULSION?
YES NO If yes, which school and reason for suspension/explusion. ______________________________________________________________
REGISTRATION IS CONDITIONAL UPON RECEIPT OF ONTARIO STUDENT RECORD FROM SENDING SCHOOL TO CONFIRM APPROPRIATENESS OF ADMISSION.
PARENT/GUARDIAN OR STUDENT (18 OR OLDER) DATE
LAST NAME FIRST NAME RELATIONSHIP TO STUDENT DATE OF BIRTH SCHOOL & GRADE
BROTHER SISTER
BROTHER SISTER
BROTHER SISTER
BROTHER SISTER
BROTHER SISTER
For addional siblings, please add siblings on a separate sheet of paper and include with registraon form
1. LAST NAME
2. LAST NAME 3. LAST NAME
FIRST NAME
FIRST NAME FIRST NAME
RELATIONSHIP TO STUDENT:
RELATIONSHIP TO STUDENT:
RELATIONSHIP TO STUDENT
HOME PHONE NUMBER
( )
CELLULAR NUMBER
( )
HOME PHONE NUMBER
( )
CELLULAR NUMBER
( )
HOME PHONE NUMBER
( )
CELLULAR NUMBER
( )
BUS. PHONE NUMBER & EXTENSION
( )
SPEAKS ENGLISH
YES NO
BUS. PHONE NUMBER & EXTENSION
( )
SPEAKS ENGLISH
YES NO
BUS. PHONE NUMBER & EXTENSION
( )
SPEAKS ENGLISH
YES NO
ADDITIONAL FAMILY INFORMATION OF WHICH SCHOOL SHOULD BE AWARE:
PLEASE ADVISE IF ALTERNATE COMMUNICATION (e.g. HARD OF HEARING, LARGE PRINT, BRAILLE, SIGN LANGUAGE) REQUIRED
Municipal Freedom of Informaon and Protecon of Privacy Act: Personal informaon on this form is collected under the legal authority of the Educaon Act, R.S.O. 1990, c.E-2, as amended. This informaon will be used
for the Ontario Student Record and for administrave purposes. Quesons regarding this collecon should be directed to the Principal or Freedom of Informaon Co-ordinator, Peel District School Board, 5650 Hurontario
Street, Mississauga, Ontario, L5R 1C6. Tel: 905-890-1010, ext. 2019.
3
Proof of Age and Immigraon Status
Canadian Birth Cercate/Registraon Card
Canadian Cizenship Card/Cercate/Passport
Canadian Permanent Resident Card/Conrmaon of
Permanent Residence
Applicaon and Receipt for Sponsorship (Applicant
for Landing)
Stage 1 Conrmaon Leer from CIC
Proof of Address/Residence in Peel
Government Issued Forms
Ulity Bill
Bank Statement/Leer from Financial Instuon
Credit Card Statement
Purchase Agreement
Immunizaon Records (only required for students
without an OEN #)
Ontario Yellow Immunizaon Card
Immunizaon Record from elsewhere
Peel Health Reference Number or Peel Health
Exempon Reference Number from online reporng
Language Informaon (for funding and emergency
purposes)
Country of Birth _______________________
Province/Territory of Birth (if Canada)__________
1
st
Entry Date into Canada __________________
Parent speaks English Yes No
Was English rst language student learned at home
Yes No
Proof of Custody (where applicable)
Living with custodial parent(s)
Cdn. Custodial Court Order
Peel Guardianship Agreement
Work Permit/Parent Study Permit (for diploma or degree)
Visitor Permit for Missionary Work (only case type 13)
Refugee Permit/Convenon Refugee
Expired Visitor Permit
Fee Paying (via Peel Schools for Internaonal Students)
Exchange Students (see OP—CISS 9 prior to registering)
Aach a copy of the Proof of Age and Immigraon Status
document to this Registraon Form
I cerfy that I have seen this document
Date: ____________________
Inial: ____________________
I cerfy that I have forwarded to Peel Health
Date: ____________________
Inial: ____________________
I cerfy that I have checked this informaon
Date: ____________________
Inial: ____________________
I have reviewed and aached the
required documentaon (if applicable)
Date: ____________________
SCHOOL CHECKLIST FOR STUDENT REGISTRATION (to be completed by School Sta)
Addional Documentaon
Report Card Transcript and/or Credit Summary Report (secondary students)
IEP (if applicable) Other Program Documentaon
Mulcultural, Selement & Educaon Partnership (MSEP) Consent – signed
I verify that I have either seen all of the documents listed personally, or the validity of the documents that I did not see per-
sonally has been conrmed to me as required by Operang Procedure – LDSS 1 The Registraon, Admission and Withdrawal
of Students. I have aached to this form the Registraon Form, copy of Proof of Age and Immigraon Status and the custody
order (if applicable). I have ensured that all informaon on the registraon form is complete and entered all elds on SIS.
Cered by: ____________________________ ____________________________ ___________________
Print name Signature Date
Legal
Last
Name
Legal
First
Name
Peel SIS #
OEN #
4
In all instances, ORIGINAL documentaon or ocially cered true copies must be presented.
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Student Registration Form (Peel Schools)

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Completed 5 September 2020

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