Student Registration Form

    STUDENT INFORMATION







    Student Gender MaleFemale





    Is English the student's first language? YESNO


    COURSE SELECTION

    Preferred Montessori Class (3 to 6 years old)
    Leefield location: AMLeefield location: PMLeefield location: Full DayMeyonohk location: AMMeyonohk location: PMEllwood location: Full DayEllwood location: Extended KPM (busing to Ellwood required)
    Preferred Out-Of-School Care (OSC) - Grade 1 to 6
    Meyonohk location: Before & After SchoolMeyonohk location: After School OnlyLeefield/Ellwood locations: After School Only (busing is required)



    FIRST PARENT/GUARDIAN INFORMATION









    Does the student reside with this individualYESNO



    SECOND PARENT/GUARDIAN INFORMATION









    Does the student reside with this individualYESNO


    EMERGENCY INFORMATION (other than the student's parent or guardian)

    EMERGENCY CONTACT 1


    EMERGENCY CONTACT 2




    STUDENT'S MEDICAL HISTORY

    Immunization up-to-date YESNO





    ADDITIONAL INFORMATION





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    en_USEnglish