Registartion

Custom Form

 


STUDENT INFORMATION


Date of Birth:    Verification Document:  

OEN:

Legal Surname:  Legal First Name:  

Middle Name: 

Legal Name in Final Year of Secondary School (if different than above):

Surname:  First Name:  

Middle Name: 

Gender:  Male  Female   Other (please specify) 

Home Phone:  Cell:  Work: 

Email Address: 

Emergency Contact Person:  Phone: 


HOME ADDRESS 


Verified Source:  Initials:

Fire #, House #:  Street/ Rd Name: 

City/ Town/ Village/ Municipality:  PO Box: 

Province:  Postal Code: 


MAILING ADDRESS


Same as Home Address?:  Yes  No     *If No, Complete below

Fire #, House #:  Street/ Rd Name:

City/ Town/ Village/ Municipality:  PO Box: 

Province:  Postal Code: 


LANGUAGE, CITIZENSHIP and STATUS IN CANADA 


Country & Province of Birth:  Citizen Of: 

First Language: 

Arrival in Canda *if not Canadian Citizen: 

Citizenship / Immigration Status:  Canadian Citizen   Permanent Resident/ Landed  Student Visa

                            Other Visa   Refugee  Other: 

                            Indigenous Ancestry  First Nation Metis  Inuit


FUNDING SOURCE


Other Pupil of the Board:  Yes   No

If yes,  Saugeen First Nation  Chippewas of Nawash Unceded First Nation


PREVIOUS SCHOOL INFORMATION


Transcript Provided: Yes   No  Have you been out of secondary school for 12 months or more? Yes  No

Last Secondary School Name:  School Board Name: 

City, Province and Country:  Entry Date Secondary School: 


MEDICAL INFORMATION

( If this section is applicable to the registering student please speak to intake personnel to fill out additional applicable medical forms)


Allergies/ Health Concern(s): 

Are any of the noted allergies/ health concerns life-threatening?  Yes   No

Additional Medical Information: 


RELIGIOUS / CULTURAL ACCOMMODATION


If you wish to request a religious/cultural accommodations, please describe: 


I certify that the information that I have provided on this form is accurate and current to the best of my knowledge. 

Print Name:  Signature:  


Please ensure you always inform our office by telephone, fax, voice-mail or letter every time you will not be in attendance.

Continuing Education students are responsible for providing the school with complete and current information.

The personal information provided on this form and any other correspondence relating to involvement in board programs is collected by Bluewater District School Board under the authority of the Education Act (R.S.O c.E.2) and regulation as amended. The information will be used to register the student in continuing education, as well as for the consistent purpose such as the allocation of staff and resources and to share information with employees to carry out their job duties. In addition, the information may be used for matters of health and safety or discipline and is required to be disclosed in compelling circumstances or for law enforcement matters. or in accordance with any other Act. Questions about this collection should be directed to the superintendent of education responsible for continuing education. 

This form will be maintained in Ontario Student Record (OSR) file. 

For non-BWDSB students, your OSR will be requested from the last secondary school you attended and stored securely by the continuing education program. For BWDSB (current/former) students, your OSR will remain at your home school, and updated appropriately. 



Security Measure
Website by SchoolMessenger Presence. © 2022 Intrado Corporation. All rights reserved.