Kindergarten Student Registration Form

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Prairie South School Division #210

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Kindergarten Student Registration Form

To submit Kindergarten application. Please complete the Kindergarten student registration form below

Kindergarten Student Registration Form

Step 1 of 14

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School Registering For:*
Registering for ?*
- This School Year
- Next School Year
Previous School Attended:
Address of previous school:
Street Address City Province
Have you ever previously attended a Saskatchewan school?*
- Yes
- No
French Immersion Program?
Applicable to École Palliser Heights and École Gravelbourg schools
- Yes

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Student Information:
Student's Name:*
Legal first name Legal middle name Legal last name
Student preferred name, if different from legal name(s):
Date of Birth (MM/DD/YYYY):*
Gender:*
- Female
- Male
- Undeclared
Grade:*
Student email address
Student Cellular Phone:
Student Home Phone:

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Citizenship:
Is student a Saskatchewan resident?*
- Yes
- No
Is student a Canadian citizen?*
- Yes
- No
If no, state citizenship:*
If you selected "No" to the question "Is student a Canadian citizen?", please enter the student's citizenship here.
Non-Canadian citizen
Proof of legal status must be provided in order to register (copy to be provided to Division office)
- Study permit
- Refugee category
- Permanent Resident Document
- Parent work permit
- Parent study permit
First language:*
Second language:
Country of birth:*
Last country student attended school:

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Student Address:
My current address is a:*
- Street Address
- P.O Box Number
Student Address:*
Street Address Apartment Number City / Town Province Postal Code
Student Address:*
If the mailing address is a box number, please also provide a physical address and/or land location.

P.O Box Number City / Town Province Postal Code
Land Location:
1/4 Section:
Section:
Township:
Range:
Riverlot:
Meridian:

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Voluntary Indigenous Self Declaration:

Overview

Parents/guardians are asked to identify their children/students as being Indigenous (First Nations, Inuit, Métis), or of non-Indigenous ancestry, during the school registration process. The choice to identify is voluntary and confidential.

Privacy

This information is stored electronically and in paper form, in the student’s cumulative file. It is secure and access is limited to Prairie South and the SK Ministry of Education. All employees within Prairie South Schools are to adhere to Administrative Procedure 180 “Guidelines for Protecting the Privacy and Confidentiality of Personal Information” and “Local Authority Freedom of Information and Protection of Privacy (LAFOIP)”.

Why self-declare?

Some individuals may be hesitant to self-declare as an ethnic group member for fear of being marginalized or because of past experiences. Information on a self-declaration form is used solely to help define programming and services to assist in the success and achievement of Indigenous students in and throughout their schooling experience. “Being proud of our culture and history impacts student confidence and creates a stronger sense of belonging” (Living Sky School Division, 2020).

The Canadian Constitution recognizes three distinct groups of Indigenous people.

First Nations / Registered / Treaty / Status (refers to an individual recognized by the federal government as being registered under The Indian Act)

First Nations / Non-Registered / Non-Status (refers to a First Nations person who is not registered under The Indian Act)

Métis (refers to a person of mixed First Nations and European ancestry who identifies as Métis, as distinct from First Nations, Inuit, or non-Aboriginal)

Inuit (refers to a person who identifies as Inuit, as distinct from First Nations, Métis, or non-Aboriginal)
Please check the box that best identifies your child/student:*
- First Nations / Registered / Treaty / Status
- First Nations / Non-Registered / Non-Status
- Métis
- Inuit
- Non-applicable

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Guardianship Rights, Custody or Access Rights:

Guardians of the student must be identified to ensure each party’s rights are respected. If an order affecting guardianship rights, custody, or access rights exists please indicate which by selecting the appropriate option(s) below.
Please select the appropriate Guardianship Rights, Custody or Access Rights:
- Access/Custody
- Guardianship
- Protection
- Other
Please specify other Guardianship Rights, Custody or Access Rights:
Other Document expiration date (MMM-dd-yyyy):
Copy in student record:
- Yes
- No
Access/Custody Document expiration date (MMM-dd-yyyy):
Copy in student record:
- Yes
- No
Guardianship Document expiration date (MMM-dd-yyyy):
Copy in student record:
- Yes
- No
Protection Document expiration date (MMM-dd-yyyy):
Copy in student record:
- Yes
- No

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Parents/Guardians Contact Information
First Parent/Guardian Contact Information:
Relationship to student - please specify:*
First Parent/Guardian Name*
First Name Last Name
First Parent/Guardian Address:*
Street Address Apartment Number City / Town Province Postal Code
First Parent/Guardian Home Phone:
First Parent/Guardian Cellular Phone:
First Parent/Guardian Work Phone:
First Parent/Guardian Lives with student:*
- Yes
- No
First Parent/Guardian Email Address:*
Please check all items that this parent/guardian should receive:
- grade mailing
- conduct mailing
- other mailing
- MSS family portal access
- Add another Parent/Guardian contact
Second Parent/Guardian Contact Information:
Second Parent/Guardian Relationship to student - please specify:*
Second Parent/Guardian Name*
First Name Last Name
Second Parent/Guardian Address:*
Street Address Apartment Number City / Town Province Postal Code
Second Parent/Guardian Home Phone:
Second Parent/Guardian Cellular Phone:
Second Parent/Guardian Work Phone:
Second Parent/Guardian Lives with student:*
- Yes
- No
Second Parent/Guardian Email Address:
Please check all items that this parent/guardian should receive:
- grade mailing
- conduct mailing
- other mailing
- MSS family portal access
- Add another Parent/Guardian contact
Third Parent/Guardian Contact Information:
Third Parent/Guardian Relationship to student - please specify:*
Third Parent/Guardian Name*
First Name Last Name
Third Parent/Guardian Address:*
Street Address Apartment Number City / Town Province Postal Code
Third Parent/Guardian Home Phone:
Third Parent/Guardian Cellular Phone:
Third Parent/Guardian Work Phone:
Third Parent/Guardian Lives with student:*
- Yes
- No
Third Parent/Guardian Email Address:
Please check all items that this parent/guardian should receive:
- grade mailing
- conduct mailing
- other mailing
- MSS family portal access
- Add another Parent/Guardian contact
Fourth Parent/Guardian Contact Information:
Fourth Parent/Guardian Relationship to student - please specify:*
Fourth Parent/Guardian Name*
First Name Last Name
Fourth Parent/Guardian Address:*
Street Address Apartment Number City / Town Province Postal Code
Fourth Parent/Guardian Home Phone:
Fourth Parent/Guardian Cellular Phone:
Fourth Parent/Guardian Work Phone:
Fourth Parent/Guardian Lives with student:*
- Yes
- No
Fourth Parent/Guardian Email Address:
Please check all items that this parent/guardian should receive:
- grade mailing
- conduct mailing
- other mailing
- MSS family portal access

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Siblings:
Does this student have at least one sibling living in the same home and attending school?*
- Yes
- No
First Sibling Information:
First Sibling Full Name:
First Last
First Sibling Date of birth (MMM-dd-yyyy)
First Sibling Current School:
Other school:
If you selected "Other school not listed here" in the Current School selection above, please specify the school name here.
First Sibling Grade:
- Add another sibling
Second Sibling Information:
Second Sibling Full Name:
First Last
Second Sibling Date of birth (MMM-dd-yyyy)
Second Sibling Current School:
Other school:
If you selected "Other school not listed here" in the Current School selection above, please specify the school name here.
Second Sibling Grade:
- Add another sibling
Third Sibling Information:
Third Sibling Full Name:
First Last
Third Sibling Date of birth (MMM-dd-yyyy)
Third Sibling Current School:
Other school:
If you selected "Other school not listed here" in the Current School selection above, please specify the school name here.
Third Sibling Grade:
- Add another sibling
Fourth Sibling Information:
Fourth Sibling Full Name:
First Last
Fourth Sibling Date of birth (MMM-dd-yyyy)
Fourth Sibling Current School:
Other school:
If you selected "Other school not listed here" in the Current School selection above, please specify the school name here.
Fourth Sibling Grade:

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Emergency Contact Information:

Who should be contacted in case of an emergency if parent(s)/guardian(s) cannot be reached?
First Emergency Contact Name:*
First Name Last Name
First Emergency Contact Phone Number*
First Emergency Contact Relationship:*
- Add another emergency contact
Second Emergency Contact Name:*
First Name Last Name
Second Emergency Contact Phone Number*
Second Emergency Contact Relationship:*

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Medical Information:
This field is hidden when viewing the form
Health Services Number (HSN):
This field is hidden when viewing the form
Doctor's Name:
This field is hidden when viewing the form
Doctor's Phone Number:
Medical Conditions
Please list any medical conditions (including allergies) that the school should be aware of, including the severity of the condition(s).
Allergies

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Child Care Information:
Daycare or child care provider name:
Daycare/Childcare Address:
Street Address Apartment Number / P.O Box City Province Postal Code
Daycare/Childcare Business Phone Number:
Daycare/Childcare Home Phone Number:
Daycare/Childcare Cellular Phone Number:

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School Bus Information:

Please Note:
High school students residing in Moose Jaw, do not qualify for bus service.
Students who live within a 1 Km walking circle of the school, do not qualify for bus service.

If student resides within the school’s boundary area, check the appropriate box below.
This student:*
- Does not require transportation
- Requires transportation from address on page one
- Requires transportation from alternate address (PreK/ K)
Click here to download fillable Bus Service Request Form, Save it and attach completed form below:
Attach completed Bus Service Request Form here*
Accepted file types: jpeg, gif, pdf, doc, docx, xls, xlsx, Max. file size: 50 MB.
Alternate Address Information: (PreK/ K Child Care Provider)
My alternate address is a:
- Street Address
- P.O Box Number
Alternate Address:
Street Address Apartment Number City / Town Province Postal Code
Alternate Address:
If the alternate address is a box number, please also provide a physical address and/or land location.

P.O Box Number City / Town Province Postal Code
Alternate Land Location:
1/4 Section:
Section:
Township:
Range:
Riverlot:
Meridian:
Reason for alternate address request:
- Second parent
- Child Care
- Other
Other alternate address request reason:
If you selected "Other" in the Reason for alternate address request, please specify the reason here.
Additional information for alternate address request:
Requested bus service start date (MMM-dd-yyyy):

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Billet Information:

In the event buses do not run due to bad weather conditions, bus failure or an emergency, we require a billet home for your student in the same town as they attend school.
Billet Name:
First Name Last Name
Billet Address:
Street Address Address Line 2 City Province Postal Code
Billet Home Phone:
Billet Cellular Phone:
Billet Business Phone:

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Consent and Release Form
Publishing and sharing student information and work*
- I give Permission for my child/self to be photographed and/or have personal information shared, as described in our Student Media Release Form
- I do not give Permission for my child/self to be photographed and/or have personal information shared, as described in our Student Media Release Form
Student Acceptable Use of Technology Form
As the parent or guardian of this student, I have read the Responsible Use Policy. I understand that technology is provided for educational purposes in keeping with the academic goals of Prairie South School Division, and that student use for any other purpose is inappropriate. I recognize it is impossible for the school to restrict access to all controversial materials, and I will not hold the school responsible for materials acquired on the school network. I understand that children’s computer activities at home should be supervised as they can affect the academic environment at school.*
As the parent or guardian of this student, I have read the Responsible Use Policy. I understand that technology is provided for educational purposes in keeping with the academic goals of Prairie South School Division, and that student use for any other purpose is inappropriate. I recognize it is impossible for the school to restrict access to all controversial materials, and I will not hold the school responsible for materials acquired on the school network. I understand that children’s computer activities at home should be supervised as they can affect the academic environment at school.
- I/ We agree to Prairie South Student Responsible Use Policy, as described in the Student Responsible Use Policy
Declaration:
I, the undersigned, hereby represent that I have the legal authority to register this student. I declare the information that I provided on this form is complete and accurate. I will notify the school of any changes to the information on this form.
Name of person submitting registration:*
First Name Last Name
Date of Declaration (MM/DD/YYYY):*
Signature of Parent/Custodial Parent/Legal Guardian*
I Agree by checking this box I the applicant acknowledge that this will act as a signature on my behalf.
Please Note:

NOTE: The school will be contacting you directly to verify name, birth date, and citizenship.
Comments
This field is for validation purposes and should be left unchanged.

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Contact Us

Prairie South School Division
1075 9th Ave N.W
Moose Jaw, SK S6H 1V7

Phone:
1-306-694-1200
Fax:
1-306-694-4955
Toll Free:
1-877-434-1200

Find us on:

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Prairie South School Division

Kindergarten Student Registration Form

Kindergarten Student Registration Form

Step 1 of 14

Student Information:

Citizenship:

Student Address:

Land Location:

Voluntary Indigenous Self Declaration:

The Canadian Constitution recognizes three distinct groups of Indigenous people.

Guardianship Rights, Custody or Access Rights:

Parents/Guardians Contact Information

Siblings:

First Sibling Information:

Second Sibling Information:

Third Sibling Information:

Fourth Sibling Information:

Emergency Contact Information:

Medical Information:

Child Care Information:

School Bus Information:

Please Note: High school students residing in Moose Jaw, do not qualify for bus service. Students who live within a 1 Km walking circle of the school, do not qualify for bus service.

Alternate Address Information: (PreK/ K Child Care Provider)

Alternate Land Location:

Billet Information:

Consent and Release Form

Student Acceptable Use of Technology Form

Declaration:

Please Note:

Please Note:
High school students residing in Moose Jaw, do not qualify for bus service.
Students who live within a 1 Km walking circle of the school, do not qualify for bus service.