Canadian Student School Registration Form Page 2
ADVERTISEMENT
1
2If your child has a medical condition you also need to
complete a medical form. Please ask Secretary for form.
MEDICAL:
FAMILY DOCTOR: Name: ________________________________ Phone #:_________________
Does your child have a medical condition?
NO _____ YES______ (If yes, please complete section below):
NAME of Medical Condition (ie Asthma, Diabetes, etc.): ______________________________________________
Name of medication(s) child takes for this condition (ie EPI-PEN, Ventolin): ______________________________
ALLERGIES (please list all allergies): ______________________________________________________________
Name of medication(s) child takes for allergy(ies): ____________________________________________________
PLEASE NOTE: Parent needs to provide medication to the school. All medications must be kept in the school office.
Students are NOT allowed to keep medication in their backpacks, lunch kits, desks, etc.
SIBLING(S)
Please list siblings who currently attend school:
Name: __________________________ Birthdate: ____________
Gr ___ School attending: ___________________
Name: __________________________ Birthdate: ____________
Gr ___ School attending: ___________________
Name: __________________________ Birthdate: ____________
Gr ___ School attending: ___________________
EMERGENCY CONTACTS
MOTHER
FATHER
(list address only if different than student’s):
(list address only if different than student’s):
Name: _________________________________
Name: _________________________________
Address ________________________________
Address ________________________________
Home phone #: __________________________
Home phone #: __________________________
Cell phone #: ____________________________
Cell phone #: ____________________________
Place of Employment: _____________________
Place of Employment: ____________________
Work phone #: ___________________________
Work phone #: __________________________
Email address: ___________________________
Email address: ___________________________
EMERGENCY CONTACT:
DAYCARE:
Daycare Name: ___________________________
(An adult who lives nearby who is able to pick up the
child from school in case of illness or emergency when
Caregiver Name: __________________________
we are unable to contact parent/guardian):
Relationship to child:
Phone #: __________________________________
Grandmother__ Grandfather___ Aunt__ Uncle __
Alternate Phone #: __________________________
Sister __ Brother __Cousin __ Friend __
Day(s) student attends (circle): M Tu W Th F
Name: _________________________________
Address ________________________________
HAVE YOU REGISTERED AT ANOTHER SCHOOL?
Home phone #: __________________________
Yes ____ No ____
Cell phone #: ____________________________
If yes, which school(s)? ______________________
Place of Employment: _____________________
___________________________________________
Work phone #: ___________________________
__________________________________
______________________
SIGN>>>>
Parent/Guardian SIGNATURE
DATE
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Life