PNSS registration

REGISTRATION FORM

Student First Name *

Student Middle Name

Student Last Name

Date of Birth *

Month

Day

Year

Gender: male/female/neutral *

Band

Treaty Number

Alberta Health Care Number *

Birth Certificate Number

Physical/Street Address

Mailing Address *

Telephone Number: Home/Cell

Previous School Attended

Principals name

Principals' School Number

Last Grade Completed

Date of Registration:/dd/mm/yyyy

Parent(s) Information/Guardian(s) *

Relationship to Student: Mother/Father/Legal Guardian *

Address *Box #/Town/Province/Postal Code

Email AddressParent/Guardian email

Telephone Number

AddressIf Different from Student

Place of Employment

Telephone NumberWork Number

Are there any special circumstances the School should be aware of? Yes(please specify) No

In rare instances, a student may be designated as "Protected" if a court has issued a restraining order under the Child Welfare Act, the Domestic Relations Act, or the Young Offenders Act. Please indicate if the school administration should be aware of any such Court Order for the protection of this student. Ifyes, please make an appointment with the Principal to discuss this matter further. Legal documentation is required.

EMERGENCY CONTACT INFORMATION Must be someone other than Parent(s)/Guardian(s) Emergency Contact 1 - Name

Telephone Number: Day/Evening

Relationship to Student:

EMERGENCY CONTACT INFORMATION Must be someone other than Parent(s)/Guardian(s) Emergency Contact 2 - Name

Telephone Number: Day/Evening

Relationship to Student

Family Doctor/Telephone number

Does your child have any medical conditions? (physical/mental/emotional