Register for sənsisyustən

Student Information

* Legal Last Name:

* Legal First & Middle Name:

Usual Name Used:

* Sex: Female
Male
Prefer not to disclose

* Birth Date:

Open the calendar popup.

Family Information

* Name(s) of Parent(s) or Guardian(s):

* Mailing Address:

* City:

* Postal Code:

House Address (if different):

* House Location: On Reserve
Off Reserve

* Home Phone:

* Email Address:

* Mother or Guardian Name:

* Living at home? Yes
No

* Cell Phone:

Work Phone:

* Email Address:

Father or Guardian Name:

Living at Home? Yes
No

Cell Phone:

Work Phone:

Email:

* Which is the best way to contact you? Cell Phone
Work Phone
Home Phone
Email

Emergency Information

* Emergency Contact Name (provide a contact different from above):

* Emergency Contact Number:

Health Information

* Doctor's Name:

* Doctor's Phone Number:

Allergies that may require immediate action:

* Medical Conditions that may require immediate action and/or school administration? Yes
No

If yes, please list.

* Care Card Number:

Citizenship Information

* Birth Country:

* Birth Province:

* Birth City:

* Language spoken at home:

* Aboriginal Ancestry: Yes
No

If yes, please select one. Status
Non Status
Metis
Inuit

Band Number:

For Separated or Divorced Parents

Guardianship: Joint
Sole

Custody: Joint
Sole

Special circumstances regarding access to student or records? Non-custodial parents are entitled to access to students, records and school personnel unless legal documents are provided that state otherwise. Yes
No

Restraining Order? Yes
No

If yes, please attach copies of court papers. Clear

* Authorization:

I authorize sәnsisyustәn House of Learning to take appropriate medical measures which may include calling an ambulance in case of an emergency if required for my child (at cost to parent). ⁫ I also allow the school to take my child on field trip with prior notice. ⁫ I will allow the school to video publish and display photos of my child.

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