PreK Application Form

Prekindergarten Application
Select the school year you are applying for:*
School receiving application:*
Previous School (if applicable):
Previous School Address (if applicable):
Did the student previously attend any other Saskatchewan pre-school(s) or school(s)?*

YesNo
List the names of the previous Saskatchewan pre-school(s) or school(s) attended. (include city/town):
STUDENT INFORMATION
Student first name:*
(as it appears on birth certificate)
Student middle name:
(as it appears on birth certificate)
Student last name: *
(as it appears on birth certificate)
Student preferred name:*
Name Used
Date of birth:*

MonthDayYear
Gender:*

MaleFemaleUnspecified
Select one of the following:*

ApartmentSuiteUnitNot Applicable
House/Apt # or Box #:*
Apartment/Suite/Unit #:*
House #:*
Street name:*
Student land location (if no civic address):*
City:*
Postal code:*
PO Box #*
INDIGENOUS SELF DECLARATION (VOLUNTARY)
An Indigenous person in Canada is a First Nations, a Métis or an Inuit person. First Nations “Registered Status” refers to an individual recognized by the Canadian federal government as being registered under the Indian Act. First Nations “Non-Status” refers to a First Nations person who is not registered under the Indian Act.
Based on the above definition do you self-declare as an Indigenous person?

YesNo
If yes, please indicate:

First Nations (Registered/Treaty/Status)First Nations (Non-Registered/Non-Status)MétisInuit
First Nations affiliation:
HERITAGE INFORMATION
The following information is collected for the Ministry of Education, and disclosure is protected under The Local Authority Freedom of Information and Protection of Privacy Act, and all employees of Regina Catholic Schools must adhere to Administrative Application 5400.
Are you a newcomer to Canada? Is the main language spoken at home one other than English? Are you or your child a temporary resident? If ANY of the above apply to your child check yes.*

YesNo
Student's country of birth:*

CanadaOther
Student's country of origin (last country of residence):*

CanadaOther
Student's citizenship:*

CanadaOther
Regina Catholic Schools personnel will contact you to discuss further documentation needed.
Is one or more parent a Canadian Citizen/Permanent Resident?*

YesNo
Is one or more parent a Canadian Citizen?*

YesNo
Regina Catholic Schools personnel will contact you to discuss further documentation needed.
Is one or more parent a Permanent Resident?*

YesNo
Regina Catholic Schools personnel will contact you to discuss further documentation needed.
First language spoken at home:*

EnglishFrenchOther
Second language spoken at home:*

EnglishFrenchNo second languageOther
Regina Catholic Schools personnel will contact you to discuss supports your child may need for a successful transition into our school.
PROPERTY TAX INFORMATION
Select one of the following*

Home OwnerRenter
Please indicate Property Tax support:

SeparatePublicSplitUnknown
City of Regina Property Taxes default to Public School Division system. For any changes to redirect taxes to the separate school system please use this link to complete the School Tax Declaration Form.
RELIGION/SPIRITUALITY INFORMATION
Religion of Parent/Guardian 1*
If no religion, type "NONE
Religion of Parent/Guardian 2*
If no religion type "NONE"
Student religion:*
If no religion type "NONE"
Parent/Guardian 1 Religion/Spirituality*
Parent/Guardian 2 Religion/Spirituality
Student Religion/Spirituality*
Parish:*
If no parish type "NONE
Is the student baptized Catholic?*

YesNo
Parish the student was baptized:
Date of baptism:

MonthDayYear
Date
PROGRAM INFORMATION
Does your child receive support from: (check all that apply)*

Speech and Language PathologistEarly Child Intervention Program (ECIP)KidsFirstWascana Rehabilitation Children's ProgramsSocial ServicesOccupational TherapistEarly Childhood PsychologistAutism Resource CentreChild and Youth Services/ReginaNone of the Above
Other outside agencies not listed
HEALTH INFORMATION
Medical notes:
PARENT/GUARDIAN 1 CONTACT INFORMATION
First name:*
Last name:*
Preferred name:*
Name Used
Relationship:*

FatherMotherStepfatherStepmotherGrandparentGuardianOther
*

Lives with StudentDoes not live with Student
Address (if different than student):
Cell phone number:*
(including area code)
Work phone number:*
(including area code)
Home phone number:*
(including area code)
Email address:*
PARENT/GUARDIAN 2 CONTACT INFORMATION
First name:
Last name:
Preferred name:
Name Used
Relationship:

FatherMotherStepfatherStepmotherGrandparentGuardianOther
Lives with StudentDoes not live with Student
Address (if different than student):
Cell phone number:
(including area code)
Work phone number:
(including area code)
Home phone number:
(including area code)
Email address:*
EMERGENCY CONTACT INFORMATION

In the event the school cannot get in touch with a primary contact. (NOTE: This contact information is for someone other than the parents/guardians identified above).
First name: *
Last name: *
Relationship:*
Home phone number:*
(including area code)
Cell phone number:*
(including area code)
Work phone number:*
(including area code)
Emergency contact address:*
CHILD CARE INFORMATION
Name of licensed daycare/pre-school/playschool or babysitter:*
Phone number:
(including area code)Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal Code
ADDITIONAL INFORMATION
Siblings ATTENDING this school:*
Siblings NOT Attending this school:*
Additional Information:
Name of person filling in the form:*
Date:*

MonthDayYear
Date
Relationship to the student:*
*

I understand that upon confirmation of registration, I will provide the school office with the student's identification documents for verification purposes. (e.g. Birth Certificate, Baptismal Certificate, Saskatchewan Health Card, Passport, Immigration Papers, etc.)
- How was the student’s name and birthdate verified?
  
  ____ Birth Certificate ____ Baptismal Certificate
  
  ____ Saskatchewan Health Services Card
  
  ____ Passport ____ Immigration Papers
  
  ____ Other _____________________________
  
  Ministry Number: __________________
  
  Name of person verifying document:
  
  ______________________________________________
- Should be Empty:

STUDENT INFORMATION

INDIGENOUS SELF DECLARATION (VOLUNTARY)

HERITAGE INFORMATION

PROPERTY TAX INFORMATION

RELIGION/SPIRITUALITY INFORMATION

PROGRAM INFORMATION

HEALTH INFORMATION

PARENT/GUARDIAN 1 CONTACT INFORMATION

PARENT/GUARDIAN 2 CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

CHILD CARE INFORMATION

ADDITIONAL INFORMATION