Waterloo Catholic District School Board - St. Louis Adult ...
Waterloo Catholic District School Board
Student Registration Form ? Continuing Education
Adult Day School Correspondence International Languages School To Work
Students who attended high school this year must present a Principal-to-Principal Form. Adult Day School students must be 18 years of age or older on the first day of classes. Correspondence students must be 16 years of age or older and have their high school's approval. International Language students must specify the course code and have their high school guidance signature on the back of
this form.
Confidential - Please Print
LEGAL NAME A.
Last Name
First Name
Middle Name
LEGAL NAME IN FINAL YEAR OF HIGH SCHOOL (if different)
Gender: Male Female Date of Birth
Year:
Month:
Day:
B. Are you attending or did you attend a secondary school this school year? Yes No
C.
Last Secondary School Attended
Last Date Attended
In City
High School Graduate
Yes No
D. Does student require an EPIPEN? Yes No Does student have any serious or potentially life-threatening conditions? Yes No
MEDICAL ALERT, CONDITION or DISABILITY
Related Notes or Remarks
E. Was student born in Canada? Yes No
IF NO, specify Birth Country:
Status in Canada:
Permanent Resident Canadian Citizen Refugee
Employment Permit Student Visa
Other Visa
IF YES, in which Canadian province?
First Arrival in Canada:
Year/ Month/ Day
Expiry Date:
Year/ Month/ Day
Country of Last Residence
Student's First Language:
Number & Street
Address
F.
Home Phone
Email Address
Emergency Contact
G.
Home Phone
Last Name
Work Phone
Country of Citizenship
Spoken at Home Main Language at home
Apt.
City
Postal Code
Cell
First Name
Cell
- 1 -
Rev: July 14
I. VOLUNTARY ABORIGINAL STUDENT SELF-IDENTIFICATION: Student is ... First Nation (Status,Non-Status) M?tis Inuit ...(check one)
The information above is collected under the authority of the Education Act, s 8.1(1) and in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Information provided will help the Ministry, school boards and schools develop programs and services for First Nation, M?tis and Inuit students; Provide accurate and reliable information on enrolment, literacy, numeracy, and graduation rates; Determine whether current programs are meeting students' needs; Provide information to inform future policy and program decision-making. Questions or concerns about should be addressed to your school principal.
Personal information contained on this form is collected pursuant to the Education Act s. 265 and the Municipal Freedom of Information and Protection of Privacy Act. Information will be used for educational planning and communications and to establish the Ontario Student Transcript (OST). Limited information may be disclosed beyond the Board for purposes such as:
- OSBIE, the school board insurer (in case of accident or witness to an accident) - The Public Health Unit - Hospital or health officials (in case of an emergency) - WCDSB Newcomer Centre (if appropriate)
Any questions related to the collection/use/disclosure of information should be directed to the principal. This form is kept until superseded.
In case of an emergency I give permission for the school to contact the name and telephone numbers provided above as `Emergency Contact'.
I verify that the information on this form is true and correct. I understand that it is my responsibility to keep the school advised of any change in the above information as soon as possible.
Date:
Signature of Student:
FOR SCHOOL USE ONLY - COUNSELOR to Complete. For INTERNATIONAL LANGUAGES , complete only part 1.
1. OEN #:
Counselor's Signature:
Home School:
Courses:
2. Fee: $
Ontario Transcript:
Yes No
Credit Counseling Summary: Yes No
Comments:
ID#:
(See Fee Structure Sheet)
Principal to Principal Transfer Request Form: Yes No Core E Teacher Referral Yes No ESL Teacher Referral Yes No Proof of ESL Level 6 Level 7
- 2 -
Rev: July 14
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