K-12 Form

STUDENT INFORMATION

Name

Legal First Name Legal Middle Name Legal Last Name

Usual Name

First Last

Date of Birth

Personal Health #:

Gender Identity

Male
Female

Gender at birth

Male
Female

Previous School Attended

Previous School District

Home Phone:

Student email:

Street Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address -Leave blank if same as street address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

PARENT/GUARDIAN INFORMATION

Last, First name:

Relationship:

Can pick up:

Yes
No

Lives with student:

Yes
No

Receive mailings:

Yes
No

Receive email:

Yes
No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone:

Work phone:

Cell phone:

PARENT/GUARDIAN INFORMATION

Last, First name:

Relationship:

Can pick up:

Yes
No

Lives with student:

Yes
No

Receive mailings:

Yes
No

Receive email:

Yes
No

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home phone:

Work phone:

Cell phone:

Emergency Contact

Name

Relationship

Home Phone

Work Phone/Cell Phone

Name

Relationship

Home Phone

Work Phone/Cell Phone

Name

Relationship

Home Phone

Work Phone/Cell Phone

Name

Relationship

Home Phone

Work Phone/Cell Phone

Daycare Contact Info:

Can pick up student:

School-Aged Siblings (Legal Names)

Name

Grade

School

Name

Grade

School

Name

Grade

School

CUSTODY/GUARDIANSHIP - Proof required if applicable

Student Lives With:

(Please specify relationship to student)

Other:

(Please specify relationship to student)

Student Lives With:

(Please specify relationship to student)

Other:

(Please specify relationship to student)

MEDICAL INFORMATION:

Please mark the box that applies if your child has one of the following serious medical conditions that may require emergency care during school hours - 911 will be called.

Diabetes
Allergy producing anaphylactic type response needing hospitalization. Allergic to:
Adrenalin
Severe asthma requiring emergency treatment
Epilepsy with a history of seizures in the past two (2) years
Blood clotting disorders (e.g. Haemophilia that requires immediate medical care in the event of an injury)
Other:

Doctor:

Phone:

Does your child routinely require medication during school hours?

yes
no- (if yes please fill out Medication Administration Form)
Third Choice

INDIGENOUS ANCESTRY (If yes, please complete this section)

Status on Reserve
Status off Reserve
Non-Status
Metis
Inuit

Status Card #

Community of Origin:

Community of Residence:

Education Program Information:

Please mark the appropriate box should your child be receiving additional educational supports and services

Student has a Ministry of Education Special Education designation and has been on an Individualized Educational Plan (IEP)
Student has been receiving regular Assistance and/or ELL support
Other

The information on this form is collected under the authority of the School Act, Sections 13 and 97. Information provided will be used for educational program purposes and, wen required, may be provided to health services, social services, or other support services as outlined in Section 79(2) of the School Act. Information on this form will be protected under the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and use of this information, please contact the principal of your school.

Signature

Proof of Residency/Proof of Age

Drop files here or

Max. file size: 2 GB.

Please upload a picture of the student's birth certificate or status card (front and back) and BC care card

Date

Eighth Avenue Learning Centre

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

PARENT/GUARDIAN INFORMATION

Emergency Contact

School-Aged Siblings (Legal Names)

CUSTODY/GUARDIANSHIP - Proof required if applicable

MEDICAL INFORMATION:

INDIGENOUS ANCESTRY (If yes, please complete this section)

Education Program Information:

Hours & Info

Latest News