Form 300-1 Updated: 2018-10-01
HOLY FAMILY CATHOLIC REGIONAL DIVISION NO. 37
STUDENT REGISTRATION FORM
|Provincial ID Number: ___________________________ Date of Registration:
1Glenmary 1 Good Shepherd 1 Holy Family 1 Rosary 1 St. Andrew’s 1 St. Stephen’s 1 Providence 1 Cyberhigh
For New Registration to Holy Family C.R.D. No. 37 please provide proof of legal name:
|SECTION A – STUDENT INFORMATION|
_____________________ ______________________ _________________
Legal Surname Legal First Name Legal Middle Name Preferred Full Name – also known as
Gender: _____________ Date of Birth: ___/___/___ Grade Attending: ____ 1 English 1 French Immersion
________________________ _______ _____________________ _____________
Street Address Box Number Town Postal Code Phone Number
Student’s Email Address: _______________________________________________________________________________________________________________
Legal Land Description (Rural Students):
Quarter ________ Section __________ Township __________ Range __________ Meridian
Please Provide 911 Address (Civic Address): __________________________________________________
Name, phone number and address of school last attended:
Name and Grade of other Children in your family:
Name and Grade Name and Grade
Name and Grade Name and Grade
|Medical Information and Support Services|
|Alberta Health Care Number: _________________________________________
Please indicate all allergies, medication and serious health problems:
Family Physician: ________________________________________ Phone Number:
Child has received services: 1 Speech/Language Therapist 1 Psychologist 1 Behavior Specialist 1 Occupational/Physical Therapist 1 Glenrose Hospital/Others 1 Received school-based Special Education Services
** Please provide a copy of specialists’ report or medical reports that require close attention.
SECTION B – PARENT INFORMATION
|Mother’s/Legal Guardian’s Name and Address:
Cell Phone Work Telephone Email Address
Father’s/Legal Guardian’s Name and Address:
Cell Phone Work Telephone Email Address
Emergency Contact Name: Telephone:
Work Telephone: Cell Phone:
Language Spoken at Home: _________________________________________
The Student lives with 1 Father & Mother 1 Mother Only 1 Father Only 1 Independent
1 Mother & Step-Father 1 Father & Step-Mother 1 Other/Guardian 1 Grandparent(s)
Who has legal custody of the child? 1 Parents 1 Mother 1 Father 1 Guardian 1 Grandparent
If legal custody is not the mother or father of the child, please provide legal documentation of appointment of guardianship. Is there anything we should know about the custody? Please provide legal documentation.
If Student requires busing:
Does your child ride the bus? 1 Yes 1 No If Yes, Bus number (if known): _____ Route Number: ______
SECTION C – CATHOLIC SCHOOL DECLARATION
|I wish to have my child registered and I support the philosophy and objectives of the Holy Family Catholic Regional Division No. 37 and those of its schools. Pursuant to the School Act, religion of parents/guardians is required.
Print Name: _______________________________________ Signature:
Do you live in an area where a Catholic School District exists? 1 Yes 1 No 1 Don’t Know
We encourage you to declare your support for Separate Schools on your Property Assessment and Tax Notice.
SECTION D – NOTICE TO PARENT OR GUARDIAN OF RELIGIOUS PERMEATION
Alberta Human Rights Act
requires a school board to give notice to a parent/guardian when courses of study, education programs, institutional materials, instruction or exercises include subject matter that deals primary and explicitly with religion.
All of the schools in this district are Catholic Separate Schools, the essential purpose of which is to fully permeate Catholic theology, philosophy, practices and beliefs, the principles of the Gospel and teachings of the Catholic Church, in all aspects of school life, including in the curriculum of every subject taught, both in and outside of formal religion classes, celebrations and exercises.
Every course of study and educational program, all institutional materials, instruction and exercises will at all times include subject matter that deals primarily and explicitly with religion.
In partial fulfillment of the right, responsibility and duty of Catholic separate schools to fully permeate Catholic theology, philosophy, practices and beliefs, the principle of the Gospel and teachings of the Catholic Church in all aspects of school life, this school is actively involved in sacramental preparation of students. To assist in sacramental preparation, please advise whether your child has received any of the following sacraments:
0 Baptism (please provide a copy of Baptismal Certificate)
0 First Communion
SECTION E – ABORIGINAL SELF- IDENTIFICATION
|If you wish to declare the student is Aboriginal, please select one:
For further information, please refer to: https://education.alberta.ca/system-support/results-report or contact Alberta Education at 780.427.8501.
If you have any questions regarding the collection of student information by the school board, please contact the School Board Superintendent at 780.624.3956.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Does the student have treaty status? 1 Yes 1 No Does the student reside on reserve? 1 Yes 1 No
On which reserve does he/she reside?
Does the student have Métis status? 1 Yes 1 No Does the student reside on a settlement? 1 Yes 1 No
On which settlement does he/she reside?
Parent/Legal Guardian Name (Please Print):
Parent/Legal Guardian Signature:
SECTION F – FRANCOPHONE EDUCATION ELIGIBILITY DECLARATION
|Pursuant to Section 23 of the Canadian Charter of Rights and Freedoms:
Citizens of Canada
In Alberta, parents can only exercise this right by enrolling their child in a French first language (Francophone) program offered by a Francophone Regional Authority.
According to the criteria above as set out in the Canadian Charter of Rights and Freedoms , are you eligible to have your child receive a French first language (Francophone) education? Please check one.
1 Yes 1 No 1 Do not know
If yes, do you wish to exercise your right to have your child receive a French first language (Francophone) education?
1 Yes 1 No
To exercise your Section 23 rights, you must enroll your child with the Northwest Francophone Education Region No. 1 – St. Isidore (780-624-8855).
Name of parent/legal guardian:
SECTION G – FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT
|The personal information requested on this form is being collected for the school registration process pursuant to the provisions of the
and its regulations (e.g. for the establishment of a student record, determination of student residency) and under the authority of the
Freedom of Information and Protection of Privacy Act (FOIP) Act.
If you have any questions or concerns regarding the collection and the intended purposes, please contact the Secretary-Treasurer for the Holy Family C.R.D. No. 37 at 10307 – 99 Street, Peace River, AB T8S 1R5 – 780-624-3956.
Declaration of Parent/Legal Guardian
I hereby certify the foregoing information to be true, correct and complete.
Parent/Legal Guardian Signature Date
SECTION H – ANTI-SPAM LEGISLATION
|In accordance with new anti-spam legislation, I give consent to receive Commercial Electronic Messages from Holy Family Catholic Regional Division No. 37. From time to time emergent and important school or Division information/news will be communicated to parent(s)/guardian(s) via mail/email and/or telephone.
FOR SCHOOL OFFICE USE ONLY – ACCEPTANCE OF REGISTRATION
|Resident Student: Registration accepted.
Principal’s Signature Date
Non-Resident Student: Registration Accepted if room and resources available.
1 room and resources available (Principal’s Initials)
provisions have been made with Resident Board for Special Education Funding. (Principal’s Initials)
Back to top