Registration

PLEASE READ THIS INFORMATION BEFORE COMPLETING THE REGISTRATION FORM

This registration form is a legal document. It must be accurate and complete. All information will be treated confidentially. Please print clearly.
Before a student can be registered by a school, a student registration form must be completed in its entirety and signed by a parent or guardian, or by the student if living independently.
The registration form must be accompanied by appropriate documentation:

Canadian Citizen: Proof of Legal Name and Age as registered by Vital Statistics of Province of Birth( I.e. Birth Certificate, Canadian Citizen Document)
Non-Resident: Visa or documentation by which the student is lawfully admitted to Canada for permanent or temporary residency, and the expiry date.
(I.e. Passport, Work/Study Permits, Student Visa)

The personal information collected on this form is part of the district registration process and use authorized under the provisions of the School Act and its regulations. All personal information collected during the registration process and during the course of the school year will be used to provide an education program and ensure a safe secure school environment.
If you have any questions or concerns regarding the collection and intended uses of this information, please contact the school principal.

Grade *

Registration Date *

Registration for *

The Current year

Next year

Anticipated Start Date

Submission Contact Information

Who should we contact in regards to this registration form?

Name *

Email *

Student Information

Write the student’s LEGAL Surname (last name) and LEGAL Given Names below. These are the names as registered with Vital Statistics of the Province of Birth as they appear on the student’s birth certificate /adoption papers.

Legal Surname *

Legal First Name *

Legal Middle Name *

Birthdate *

Gender *

Male

Female

Unspecified

Birth Certificate *

Attached

Not Available

On File Already

Upload Birth Certificate *

Choose File No file chosen

If the student uses a different last name or first name other than what he/she has been legally registered, please indicate “Preferred Names”.

Preferred Surname

Preferred First Name

Home Phone

Student Cell Phone

Address of Residence

Address *

City *

Postal Code *

Province *

Mailing Address

Address

City

Postal Code

Province

Rural Students (Billet)

Quarter,

Section

Township

Range

West of the

Meridian

School History

Has your child ever attended school in LPSD? *

Yes

No

If yes, please indicate the school

Last School Attended *

City/Town

Province

Country (If other than Canada)

Has your child ever attended school in Saskatchewan? *

Yes

No

If so, please indicate the school and City/Town *

If available, please provide SK Learning ID#

Has your child ever attended school in Alberta? *

Yes

No

If so, please indicate the school and City/Town *

Medical Information

Are there any serious medical conditions about which you wish the school to be aware of?

Allergies (Please specify below)

Diabetes

Haemophilia

Epilepsy

Heart Condition

Asthma (On medication?):

Yes

No )

Additional Information (hearing, vision, physical needs)

Parent or Guardian Information

Complete all Parent/Guardian Contact information whether or not Parent/Guardians are living together.

In rare instances a student may be designated as “Protected” if a court issued restraining order under the Youth, Child and Family Enhancement Act, the Domestic Relations Act, or the Young Offenders Act.

Please indicate if the school should be aware of any such court order for the protection of the student. *

Yes

No

Note: If yes, please make an appointment to discuss this situation with the school administration. You will need to supply legal documentation.

Student lives with *

Both Parents

Father Only

Mother Only

Father/Stepmother

Mother/Stepfather

Guardian

Other

If other please specify

Contacts

Contact Information 1

Relationship to Student *

Surname *

First Name *

Title

Address (If different to student)

City/Town

Province

Postal Code

Home Phone *

Cell Phone

Business Phone

Ext.

Other Phone

Email

Emergency Contact Information

Emergency Contact should be someone other than the student's parents.

Relationship to Student *

Surname *

First Name *

Title

City/Town

Province

Postal Code

Home Phone *

Cell Phone

Rural Students (Billet)

It is VERY IMPORTANT that we have an In Town Billet in case of inclement weather.

Surname

First Name

Title

City/Town

Province

Postal Code

Home Phone

Cell Phone

Aboriginal Ancestry (Optional)

If you wish to declare that you are an Aboriginal person, please specify.

Status Indian/First Nations

Band Affiliation

Treaty Status No.

Non-Status Indian/First Nations

Metis

Inuit

Alberta Learning is collecting this personal information pursuant to section 33(c) of the FOIP Act as the information relates directly to and is necessary to meet its mandate and responsibilities to measure system effectiveness over time and develop policies, programs and services to improve Aboriginal learner success. For further information or if you have questions regarding the collection activity, please contact the office of the Director, Aboriginal Policy, Policy Sector, Information and Strategic Services Division, Alberta Learning, 10155 102 Street, Edmonton, AB. T5J 4L5 (780) 427-8501.

Citizenship and Documentation

Birth Language *

English

Other

If other please specify

Country of Birth *

Canada

Other

If other please specify

Country of Citizenship *

Canada

Other

If other please specify

Current Language (Spoken in the home) *

Select All that Apply

A Child of an individual who is lawfully admitted to Canada for permanent or temporary residence (does not apply to tourists/visitors)

Lawfully admitted to Canada for permanent resident

A Child of a Canadian Citizen

Study Permit (Parent/Guardian residing in another country)

Parent Work Permit

Documentation Expiry Date

Parent/Student Permanent Residency

Documentation Expiry Date

Student Study Permit

Documentation Expiry Date

Citizenship Card

Documentation Expiry Date

Temporary Resident

Documentation Expiry Date

International Student Visa

Documentation Expiry Date

Non Resident Students

The school is required to obtain a copy of the student documentation as well as a copy of the student passport reflecting Demographics, Canadian Authorization Stamp and Expiry Date.

A copy of the passport has been obtained for the student cumulative record

Yes

No

Authorization Expiry Date (DD/MM/YYYY)

Tuition Fees

Visiting or Exchange Students (Code 412, 413, 415, 416) are required to pay tuition fees.

Tuition fee explained to parent/guardian as a condition of enrollment?

Yes

No

Superintendent of Administration notified (only if tuition fee to be invoiced)?

Yes

No

Date Notified

Consent for Student: Computer Network Acceptable Use and Publishing Student Work and Information

Computer Network Student Registration: Division Computer Network. Acceptable Use for Internet and Electronic Mail As a parent or legal guardian, I have read the information about the appropriate use of technology (email and online access). The signatures of the parent/guardian are mandatory before access is granted to the Lloydminster Public School Division Network.

Publishing Student Work and Information: When images and names of students are shared with the public, either through school division publications, media coverage, video footage or on websites, the Saskatchewan Local Authority of Freedom of Information and Protection of Privacy Act (LAFOIP) must be followed. We require your informed consent to share personal information about your child. Please see our LAFOIP Information page for more information.

By checking the boxes below, I/we understand this consent shall remain in effect as long as the student remains registered with the Lloydminster Public SchoolDivision and that I may be required to complete an additional form should the status of the student enrolment change. I/we also understand that this consent maybe withdrawn by myself/us at any given time, upon written notice. I/we have given this consent voluntarily.

Descriptions and Consent

Acceptable Use AP 140

My child and I have read and understand the LPSD Acceptable Use Policy. By checking this box, I consent that my child may usethe email and the Internet while at school according to the rules outlined in the Administrative Procedure 140. Also by checking this box, I am confirming that my child has agreed to comply with the stated rules and to use the network in an educationally constructive manner.

LAFOIP for Education Purposes in School Community

I give permission for my child's likeness and/or information being used in the school newsletter and school yearbook.

LAFOIP for School and Division Based Education Purposes

I give permission for the school division to create and publish photographs, video recordings and audio recordings of my child, which may be used on the classroom, school or division websites and social media sites that have been registered with LPSD such as Facebook, Twitter and Blogs.

LAFOIP for Media Coverage

I give permission for my child to take part in media coverage. I understand this may include photographs, interviews and video recordings for television, radio, newspapers, etc. Once informed consent is given, your child will only be interviewed, etc. by representatives from media outlets only if they are comfortable doing so.

Name of Siblings at school

Name of siblings at home

Declaration by Parent, Guardian or Independent Student

I hereby certify the above information to be true, correct and complete. *

Signature (Enter name of Parent/Guardian/Independent Student) *

Date *

Province	Age Criteria	Effective Date
Saskatchewan	Less than 22	September 30
Alberta	Less than 20	September 1

Registration

Online Registration Form

PLEASE READ THIS INFORMATION BEFORE COMPLETING THE REGISTRATION FORM

Submission Contact Information

Student Information

Address of Residence

Mailing Address

Rural Students (Billet)

School History

Medical Information

Parent or Guardian Information

Contacts

Contact Information 1

Emergency Contact Information

Rural Students (Billet)

Aboriginal Ancestry (Optional)

Citizenship and Documentation

Non Resident Students

Tuition Fees

Consent for Student: Computer Network Acceptable Use and Publishing Student Work and Information

Descriptions and Consent

Name of Siblings at school

Name of siblings at home

Declaration by Parent, Guardian or Independent Student

New Student Registration

Funded Students Age Limits

Avery Outreach School