Student Registration Form - 2024-2025 School Year

School Registration

Saipoyi

Aahsaopi

Tatsikiisaapo’p

Kainai High School

Kainai Alternate

Blackfoot Immersion

Transportation

Bus Number

Location

KBE

Cardston

Lethbridge

Fort Macleod

Glenwood

Other

Explain

Home Address

Street, Apt / Suite

City / Town

Province / State

Zip / Postal Code

Does the student live off-reserve?

Y

N

Exact Location/ description of residence

Previous school attended

Mailing Address

Street, Apt / Suite

City / Town

Province / State

Zip / Postal Code

Guardian Info

Does this student reside with you?

Yes

No

Relationship to student

Day Phone

Home Phone

Email

Emergency Contacts Information

If a parent or guardian is unavailable, list persons authorized to care for the child in case of an emergency. Please ensure that the person(s) are aware that their name has been used.

Name

Day Phone

Home Phone

Work Phone

Student Medical information

Physician

Clinic

Phone

Alberta Health Care #

If the child has a health condition and/or recurring health concern of which the school should be aware of (i.e. allergies), please provide information

If there any impairments to vision, hearing, speech, language problems, or diet considerations, please provide information

Is your child's immunization up to date?

Yes

No

In the event of an emergency when I am not available, I authorize the administration of any medical procedures deemed necessary by my doctor, or by any other physician selected by the Designate of the school. I also authorize the school to provide or allow the provision of Health Care to my child, only upon written consent of the child’s parent, or the Health Care provided is in the nature of First Aid/CPR

Parent/guardian signature

Services Information

Is there a current custody agreement?

Yes

No

If Yes, please provide custody information

Alternate Residence

List alternate residencies, name(s), & relationship(s) (Kinship agreement)

Student Services Data

Does this child/student receive Special Education Programming/Special Services?

Yes

No

If Yes, please list services you currently access:

Kainai Child Protection Services Data

Is this child/student in care and do they have a case worker?

Yes

No

Case worker name

Case worker work/location

Case worker phone

Case worker email

Siblings

List any siblings name and age

Name

Age

FNMI

Student Aboriginal Status

Status / First Nation

Non-Status / First Nation

Inuit

Band Name

Blood

Peigan

Siksika

Other

Explain

FNMI

Yes

No

AUDIO AND VIDEO RECORDING

The use of audio and/or visual recording methods for diagnostic, therapeutic, or educational purposes occurs only with full knowledge of the purpose by the client and guardian, and with their written approval. The written approval will describe the intended use of the recording. Parents/Guardians will be contacted by the school for separate written consent in the following instances: audio and visual taken where the material will be used outside of the program, release of student names outside of the program, copyright for artwork or creative writing which will be reproduced for use outside the program, or used on the school website, and acceptable use of IT services and hardware. Names WILL NOT be published with any pictures.

Name

Date

Signature

Principal or Program Coordinator

Principal or Program Coordinator Signature

Acknowledgement

I have read and understand the uses that will be made for the personal information as listed above, and I hereby certify that the information provided by me on the registration form is true, correct and complete to the best of my knowledge and belief.

Name

Date

Signature