REGISTRATION PACKAGE 2023 – 2024 SCHOOL YEAR

STUDENT INFORMATION

Parents with a student entering K4 or K5 must provide profile of age. You may submit a copy of one of the following: Birth Certificate or Alberta Health Care Card

Legal Name As It Appears On Birth Certificate

Legal First Name

Last Name

Middle Name

Student also known as

Birth Date MM/DD/YY

How do you identify? Gender: Male Female Other

Grade Entering

E-mail of Student

Alberta Health Care #

Treaty #

Band Name

How do you identify? Status Non-status Metis Inuit Other

Mailing Address

Box #

Town

Postal Code

Living on Kapawe'no First Nation: circle Yes/No/Other

House #

Location Description:

Legal Land Location

If other please enter residential address

If drop off location is different from pickup please make note here of the name of the resident, house number and contact phone number.

PARENT / GUARDIAN INFORMATION

Student resides with: circle one both parents / mother only / father only / joint custody / kokum / mosum / legal guardian

Legal Custodian #1

Name of Legal Custodian

Relationship

Phone:

Work Phone

E-mail of Guardian

Cellphone

Custody Information
In rare instances, a child may be designated as “Protected”. If a court issues a restraining order under the Child Welfare Act, The Domestic In Other Relations Act or the Youth Criminal Act affecting the custody or access rights to the student, a copy will be required to be placed in the student’s record ensuring that the order can be properly enforced. Please discuss the situation with Kapawe’no Holistic Knowledge Academy (KHKA) administration. Please indicate if any restraining or custody access order exists, circle YES / NO and provide a copy to be kept on file.

Emergency Contact Information

Name to contact:

Relationship

Phone/Work Phone/Cellphone

In the event of an emergency, does the above contact have permission to pick the student up from school? YES / NO

PREVIOUS SCHOOL INFORMATION

Last School Attended:

Last Grade Attended

Last School Address

Last School Phone#

Is the student currently under supervision by another school? Circle YES / NO

Has the student been expelled from school? Circle YES / NO

Was the student readmitted? Circle YES / NO

Special Needs: please identify any special needs, learning difficulties or special education programs your child has or will need.

MEDICAL INFORMATION

Name of family doctor

Contact # of Doctor

Please identify and explain ay special medical conditions, problems or allergies. ( i.e. eye glasses, hearing aids, diabeties seizers):

Does your child require medication? Please list:

*If your child requires medication, please attach a doctor’s note naming the medication and dosage*
*The parent is required to fill out a “Consent to Administer Medication” form so that staff can administer needed medications*

STUDENT INFORMATION RELEASE

I hereby consent for (Student Name)

*to have the student’s name, photo and comments used in the school calendar, newsletters or other school publications (webpage?) *to have his/her name released for recognition of acheivement in academic, athletics or community involvement
*to have his/her name address and telephone number in the student record system
*to have his/her work on display
*to have his/her work reproduced
Which are produced during the current school year for non-profit, educational purposes. I understand such production(s), work(s) may be shown in educational displays during board sponsored open houses, in-service sessions and other school related ativitiesat the school or school board locations. They may also be shown at school or school board sponsored displays in the community or used in the school.
*This consent is valid for the period during which the above named student is at this school, but may be withdrawn at anytime upon written notice
*If student is under the age of 16 years only the signature of the parent is required*
*If student is 16 or 17 years of age during the school year, signature of the parent/legal guardian is required*
*If student is 18 yeard of age or older, signature of the student is required*
I hereby declare that I have read and understand the information contained in this form and that the information I have provided is correct.

In the case of medical emergency where the parents of designated contact cannot be contacted, permission is given to the Principal to have my child taken to the hospital and/or have emergency treatment administered: Please type YES or NO

I would like to Register for Kapawe’no Nêhiyawak School (In Person): Please type YES or NO

I would like to Register for First Nation Virtual Learning Centre: Please type YES or NO

I hereby give permission to the Kapawe'no First Nation School to administer any achievement, diagnostic, screening tests that may be beneficial to the educational planning for my child: Please type YES or NO

By clicking the submit button, you hereby declare that you have read and understand the information contained in this form and that the information you have provided is correct.

PLEASE ADVISE THE SCHOOL IMMEDIATELY OF ANY CHANGE IN THE INFORMATION DURING THE SCHOOL YEAR

If you want a printable form instead, you may download the copy here.

Kapawe’no Holistic Knowledge Academy
P.O. Box 10
Grouard, AB T0G 1C0

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