Original File From Success
Original File From Success
Notice to Parent/Guardjan
Thank you for your interest in an elementary education with the Grand Erie District School Board. To register a student, the
parent/guardjan is required to provide information tb the school by completing this Registration Form. Ensure that you complete all
sections and provide the school with all of the original documéntation requlred, as noted on the form.
BIRTH DATE - MM/DD/YYYY GENDER LIVES WITH: Is there a court order regarding custody?
Female Mother Legal Guardian No if es rovide
documentation
ADDRESS HOME PHONE NUMBER
6478253420
Apt/Urdt: UPPER House: 66Full Street Name: Marlborough street Citynown: Brantfort postal Code: N3T 2S3
Please help us to understand special living arrangements (e.g., student does not live with a parent) and/or custody orders by provldlng details here:
MÅIN.* 6478253420 o
APDRESS (if different from stÜdent)
2ND.
3RD; o
Apt/Unit House Full Street Name
E-MAIL ADDRESS (only; if y6u consent to ieceiVe Emails fio}fi the
[email protected]
own Code
NOTES— PARENT/GUARDIAN ifVou Wish to provide information that will help us to understand the student's family context such as stepparent, common-law spouse
MAIN: ooo
ADDRESS (if different from student) 2ND. ooo
E-MAIL' ADDRESS (only if you consent to recelve emails from the schoo}):
NAMES OF SIBLINGS ATTENDING SCHOOLS IN GRAND ERIE who live at the same address as the student
SCHOOL HISTORY
DETAILS OF PREVIOUS SCHOOLING OEN (Ontario Education Number) if known
EMERGENCY CONTACT (other than parent/guardian) Can ptck up student RELATIONSHIP PHONE(S): 6478253245
Yes
EMERGENCY CONTACT (other than parent/guardian) Can pick up student RELATIONSHIP PHONE(S): 6478253683
Yes
EMERGENCY CONTACT (other than parent/guardfan) Can plck up student RELATIONSHIP PHONE(S): +1 (226) 966-6397
Yes
have obtained the consent of the person(s) Eisted above to have their name and telephone number used for emergency purposes Yes
STUDENT WALKS
ÄÖDltTÖNÄL iNÉöÄMÄilötv
SELF-IDENTIFICATION (if applicable) this is voluntary/optlonal First STUDENT LIVES ON:
NationsO MétisO Inuit Dix Nations of the Grand River OMississaugas of the Credit
LUNCH BREAKS It importantthatwe know_where your chiidren are. Students who eat atschool must previde a signed, dated note with your consent to leave
school property during breaks.
Please Indicate whether your child: WILL be eating at school