HomeMy WebLinkAboutOCDSB 224 Application for Admission to Elementary School PRINT COPYOCDSB 224 Admissions & Enrolment (September 2017) 1
Application for Admission to Elementary School
School Name:
Legal Surname:
Legal First Name:
Legal Middle Name:
Preferred Surname:
Preferred First Name:
Preferred Middle Name:
Gender:
Student’s Date of Birth:
Present Grade:
Present Program:
List of Siblings in the
School Board:
Health Card Number: Version:
Medical Alert Information/Disability/Allergies:
Country of Birth:
Province of Birth:
Country of Citizenship:
Status in Canada:
First Arrival Date to Canada:
Languages Spoken at Home:
Main Language at Home:
Home Address
Street Number: Street Name:
City:
Home Phone: Listed:
Postal Code:
Unlisted:
Special Education
YES NO Has your child ever received special education assistance:
If “YES” to above, provide dates and locations:
Voluntary Indigenous Self-Identification
Is your child of Indigenous descent or ancestry? YES NO
If “YES” to above, please indicate: First Nation Inuit Metis
Has your child ever attended an OCDSB School?
Previous School: Previous School Board:
Previous Program:
School Use Only
Student No.:___________________
Grade:_______________________
Admit Date:___________________
Program:_____________________
OEN:________________________
Homeroom:___________________
Age Verification:_______________
Address Verification:____________
Male Female
Province:
Apartment:
YYYY MMM DD
TRAVEL
Additional information:
If student is eligible
to take a school bus
PICK UP point is nearest to the address of DROP OFF point is nearest to the address of
(check one
box only)(check one
box only)Student Caregiver Second Parent/
Guardian Student Caregiver Second Parent/
Guardian
Recommended STEP Placement 1-6
ESL
ELD
Oral
Oral
Reading
Reading
Writing
Writing
NO ESL
ESL/ELD Program (FRC USE ONLY)
Prefer not to disclose Self Identify:__________
2 OCDSB 224 Admissions & Enrolment (November 2018)
Parent / Guardian Information Student Name:
Surname:
Status in Canada:
Relationship to Student:
Place of Employment:
Emergency Contact Priority:
Home Phone No.: Cell.:
E-mail (1): Custody:
Lives with Student:
Access to Records:
School Closure Contact Priority:
Business Phone No.:
Guardian:
Agency Name (if applicable):
Address (Street Number):
Receives Mail:
Street Name:
(if different from student)
City/Township:
Unit/Apartment:
Surname:
Status in Canada:
First Name:
Relationship to Student:
Place of Employment:
Emergency Contact Priority:
Home Phone No.:
E-mail (1):
School Closure Contact Priority:
Business Phone No.:
E-mail (2):
Cell
Custody:
Lives with Student: Agency Name (if applicable):
Access to Records:
Address (Street Number):
Receives Mail:
Street Name:
(if different from student)
City/Township:
Unit/Apartment
Emergency Contact Information (Other Than Parents / Guardians)
Surname:
Relationship to Student:
Emergency Contact Priority:
First Name:
Place of Employment:
School Closure Contact Priority:
Home Phone No.: Business Phone No.: E-mail:
Caregiver Information
Surname:
Emergency Contact Priority:
Home Phone No.:
City/Province:
First Name:
School Closure Contact Priority:
House No. & Street:
Postal Code:
_______________________________________________ _______________________
Parent / Guardian Signature (Please print this form) Date
Acknowledgement
The personal information on this form is collected under the authority of the Education Act (RSO. 1990 c.E.2) and in accordance with the Municipal
Freedom of Information and Protection of Privacy Act (RSO. 1990 c.M56), as amended. It will be used to establish the Ontario Student Record [OSR] and
for student and education related purposes such as registration, administration, communication, collection of fees, data reporting, and Student
Transportation Services. In addition the information may be used or disclosed to comply with legislation, for compelling circumstances affecting health and
safety or discipline, as required in circumstances related to allow enforcement matters, and with third parties in accordance with established service
agreements or in accordance with any other Act. Questions or concerns should be directed to the school principal or the Board’s Freedom of Information
Coordinator, Ottawa-Carleton District School Board, 133 Greenbank Road, Ottawa, Ontario, K2H 6L3, Telephone 613-596-8211 613-596-8211 ext. 8607.
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To be filed in OSR
First Name:
E-mail (2):
Guardian:
Province:
Province:Postal Code:
Postal Code:
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