Inscription

Private School Enrollment Form

Student Information

Full Legal Name

Grade

Birth City/State

Date of Birth

Country of Birth

Gender

Male Female

Previous IEP

Yes No

Previous School

Diagnostic (If Applicable)

Family 1 (Student's primary / Residential Family)

Guardian (Full legal name)

Relationship

Cellphone

Work Phone

Courriel

Tuteur Légal

Yes No

Authorize to Pick up

Yes No

Family 2 (Student's Secondary Family if applicable)

Guardian (Full legal name)

Relationship

Cellphone

Work Phone

Courriel

Tuteur Légal

Yes No

Authorize to Pick up

Yes No

Emergency Contact Information

Informations de Contact

Relationship to Student

Phone Number

Medical Information

Does the student have any allergies

Yes No

If Yes please list:

Does the student have any medical conditions we should be aware of?

Yes No

If Yes please specify :

Primary Physician Name

Primary Physician Phone Number

Health Insurance Provider

Policy Number

Consents & Agreement

Birth Certificate

Inmunization Records

Address Proof

Other

I certify that the above information is correct to the best of my knowledge.

I give permission for my child to receibe emergency medical treatment if necessary

I understand that submitting this form does not guarantee admission, the school will review applications and notify parents accordingly

Inscription

Private School Enrollment Form

Student Information

Family 1 (Student's primary / Residential Family)

Family 2 (Student's Secondary Family if applicable)

Emergency Contact Information

Medical Information

Consents & Agreement

Liens Rapides

Assistance

Informations de Contact

Bourses

FLDE