NLSD Division - School Registration

Student Registration Form

NLSD-JPG-corp-fullcolour smaller

Northern Lights School Division No. 69

6005-50 Avenue
Bonnyville, Alberta
T9N 2L4

PHONE: (780) 826-3145 (780) 826-3145 FAX: (780) 826-4600

The information requested on this form is being collected pursuant to the School Act, Section 23, A.R. 71/99 and the FOIP Act, Sections 33(c), 39(1)(b) and 40(1)(c). Information acquired through this form is kept secure and access is restricted.

PLEASE NOTE: Please register at HIGH SCHOOLS in person only! Students are required to meet with the guidance counselor/principal and do course selection in order to complete registration.

A COPY OF STUDENT BIRTH CERTIFICATE OR VISA/IMMIGRATION DOCUMENTATION IS REQUIRED FOR ALL STUDENTS.

NLSD-JPG-corp-fullcolour smaller

Northern Lights School Division No. 69

6005-50 Avenue
Bonnyville, Alberta
T9N 2L4

PHONE: (780) 826-3145 (780) 826-3145 FAX: (780) 826-4600

PLEASE NOTE: Please register at HIGH SCHOOLS in person only! Students are required to meet with the guidance counselor/principal and do course selection in order to complete registration.

A COPY OF STUDENT BIRTH CERTIFICATE OR VISA/IMMIGRATION DOCUMENTATION IS REQUIRED FOR ALL STUDENTS.

SCHOOL LOCATION

Please select a school : *

STUDENT INFORMATION

Student's Legal Name

Last * First * Middle

Student’s Preferred Name(if different from above)

Last First Middle

Date Of Birth: MM/DD/YYYY * AGE as of Sept 1: Grade * Gender Male Female * Street Address * City * Postal Code

Mailing Address (if different from above)

Postal Box Postal Code Please select Land Location NE NW SE SW Section Township Range( W4 ) Rural 911 Address Citizenship Canadian Other * Student’s Home Telephone (if different than parent’s number) Student’s e-mail address

PARENTS AND/OR GUARDIANS

PARENTS AND/OR GUARDIANS Mother Father Legal Guardian Other Other Name Address City Prov Postal Code Country Home Telephone Number Day Phone Number Cell E-mail Is to receive mail from school? Yes No

CUSTODY INFORMATION

Student Lives With Both Parents Mother Father Legal Guardian Other (please specify)

If a custody order or any other legal document governing the custody or guardianship of your child exists, a copy of the most recent custody document must be placed in the student record. Please indicate if the school administration should be aware of any such Court Order for the protection of your child.

Please select Yes No

If ‘yes’, please make arrangements to discuss this situation with the school administration. Legal documentation will be required.

INDEPENDENT STUDENT STATUS

Students 18 years of age or older, or “independent” under the School Act.

Any student 18 years of age and older or 16 years of age and older and considered legally “independent” (not living at home and providing solely for themselves) may complete this form and register in the Northern Lights School Division without parental consent. Proof of Independent Status must be presented.

Are you declaring independent status? Yes No

(If Yes, please attach or send us a proof of independent status.)

Attachment goes here ( if any )

SIBLINGS INFORMATION

Do you have other children attending this school? Yes No

(if yes, please list their names and grades)

The provision of sibling information is optional and is collected for communication purposes.

Name Grade Name Grade Name Grade

EMERGENCY CONTACT

It is essential that you provide the names and phone numbers of individuals who have given their permission to be contacted in the case of emergency if the school cannot reach the parent or guardian listed above.

Emergency Contacts 1

Name Relationship to Student Home Phone Number Business Phone Number Cell Phone Number

Emergency Contacts 2

Name Relationship to Student Home Phone Number Business Phone Number Cell Phone Number

Emergency Contacts 3

Name Relationship to Student Home Phone Number Business Phone Number Cell Phone Number

LAST SCHOOL ATTENDED

Name of School Grade Address Postal Code Phone Number

BUSING INFORMATION

Bus Number Bus Driver

MEDICAL INFORMATION

Are there any particular medical problems your child may be experiencing which his/her teacher should be aware of?

Please check : Physical Disabilities Allergies Serious Illness Please explain (1000 chars left)

**Student lists will be provided to the Regional Health Authority upon request from the RHA. See Section 5(4) of the Student Record Regulation A.R. 71/99

SECTION 23 FRANCOPHONE EDUCATION ELIGIBILITY DECLARATION

Pursuant to Section 23 of the Canadian Charter of Rights and Freedoms: Citizens of Canada whose first language learned and still understood is French; or who have received their primary school instruction in Canada in French have the right to have their children receive primary and secondary instruction in French; or of whom any child has received or is receiving primary or secondary school instruction in French in Canada, have the right to have all their children receive primary and secondary school instruction in the same language. 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.

A. 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 place an X in the appropriate box.)

Please select : Yes No Do not know

B. If yes, do you wish to exercise your right to have your child receive a French first language (Francophone) education?

Please select : Yes No

SPECIAL PROGRAMMING

English as a Second Language: Please check if you are eligible for ESL Programming (one criteria is that your child’s mother tongue is not English). Please check if your child has an IPP or special programming.

FRENCH IMMERSION

French Immersion is offered in the following schools in the Northern Lights School Division:

North Star Elementary – Cold Lake – Kindergarten to Gr. 4
Cold Lake Middle School – Cold Lake – Late Entry Gr. 4-8
Ecole Plamondon School – Lac La Biche – Kindergarten to Gr. 5

Please check if you are registering for the French Immersion Program. Yes No

ABORIGINAL LEARNER

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

Aboriginal Checked Status/First Nations
Non-Status/Non-First Nations
Metis
Inuit
Band Living on Reserve Yes No Treaty

Alberta Education is collecting this 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, please contact the office of the Director, Aboriginal Policy Sector, Alberta Education at (780) 427-8501.

Under Section 23 of the School Act, students/parents are entitled to review their children’s student records. The record, if still in the possession of the Northern Lights School Division No. 69 after the student’s twenty-fifth birthday, shall be destroyed.

If you have any questions regarding this request for individual student information and about our use or disclosure of student information, please contact your School FOIP Coordinator or the NLSD FOIP Coordinator at 6005-50 Avenue, Bonnyville, Alberta, T9N 2L4. The phone number is (780) 826-3145 and fax is (780) 826-4600.

SIGNATURE REQUIRED: I hereby declare that I have read and understood the information contained on this form and the information I have provided is correct.

By Checking this box you are providing your consent Date Parent's name

NOTICE OF ACTIVITIES
(as required by the Freedom of Information and Protection of Privacy Act, Sections 33, 34, 39 and 40)

PARENTS – PLEASE READ CAREFULLY

The purpose of this notice is to inform you about the collection and use of student information by Northern Lights School Division No. 69.

In many cases the information is specifically mandated under the School Act, such as the information provided when a student is registered. For example, the Division must provide Alberta Education with specific information on each student. Certain information may also be required by the Regional Health Authority or other Ministries. In other instances, personal information is collected and used for authorized programs and activities that are a normal part of school life. These uses, which are listed below, are a vital part of a healthy and functioning school and participation of all students is very important. We realize, however, that there may be occasions where you, as parents or guardians, have concerns relating to the safety of your child with any of these uses of information. If this is the case, please contact the school office.

Effective the 2013-2014 School Year and continuing for as long as your child is a student in the school that he/she is currently registering in, all parents are requested to review the following information and either provide consent or specify considerations where you are withholding consent. Parents of continuing students in the same school will not be asked to sign this consent form each year. What is marked on this consent form will be used at the school for as long as your child attends this specific school or until you inform the school in writing of a change or if you are revoking your permission.

Types of activities where information may be collected or used include:

1: The use of student names in lists for planning, for emergency procedures, in managing busing issues, and in coordinating school activities.

2: The taking of individual, class, team, or club photos for school purposes and the use of student photos for students’ union cards or other identification purposes;

3: The use of students’ names on artwork or other creative work or material of students displayed at science fairs, other project displays at school or school board sites and school related/sponsored activities;

4: The use of student names in honor rolls, work ethic listings, citizenship rolls, graduation ceremonies, scholarship or other awards with the school or school board;

5: The use of student names and academic information necessary for determining eligibility or suitability for provincial, federal, or other types of awards or scholarships in the event the board applies on a student’s behalf;

6: The use of student names, related contact information and telephone numbers for absenteeism verification;

7: The use of a student’s name, photo, and comments in the school newsletter, yearbook, calendar, graduation book or other school publications. (Where the school newsletter or publication will be posted to the school website or NLSD website, a separate and specific consent will be required)

8: The taking of photos and/or videos of classroom activities, and their use by the media or other organizations where students are not interviewed or identified by name or face (Where individual students are identified or interviewed and the material will be used outside the school, a separate and specific consent will be required). Please note that photos and/or videos of school activities that are open to the general public may be taken and used for purposes within and outside of the school. Such photos or videos do not require consent;

9: The taking of photos/videos of classroom or other school activities by the school board where the material will be used within the school (where individual students are identified or interviewed and the material will be used outside the school, a separate and specific consent will be required and you will be contacted prior to the disclosure taking place);

10: Mandatory disclosure of both student and parent information to assist the Regional Health Authorities with communicable disease intervention and follow-up (such as vision, speech, hearing, dental, immunization programs). Lists will be provided to the local Health Unit authorities upon their request.

11: The circulation of information on a “need-to-know” basis regarding students who have severe or life-threatening medical conditions.

I hereby give permission for the school to use information/photos for my child for all purposes specified above.

Security

Northern Lights School Division No. 69

6005-50 Avenue
Bonnyville, Alberta
T9N 2L4

PHONE: (780) 826-3145 (780) 826-3145 FAX: (780) 826-4600

PLEASE NOTE: Please register at HIGH SCHOOLS in person only! Students are required to meet with the guidance counselor/principal and do course selection in order to complete registration.

A COPY OF STUDENT BIRTH CERTIFICATE OR VISA/IMMIGRATION DOCUMENTATION IS REQUIRED FOR ALL STUDENTS.

Thank You For Contacting Us

Quicklinks

Contact Us

Donate to NLSD No. 69

Student Registration Form