Pre-K Application Form

Pre-K 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)?

Yes No
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: *

Month Day Year
Gender: *

Male Female Unspecified
Select one of the following: *

Apartment Suite Unit Not 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?

Yes No
If yes, please indicate:

First Nations (Registered/Treaty/Status) First Nations (Non-Registered/Non-Status) Métis Inuit
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.
Student's country of birth: *

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

Canada Other
Student's citizenship: *

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

Yes No
Is one or more parent a Canadian Citizen? *

Yes No
Regina Catholic Schools personnel will contact you to discuss further documentation needed.
Is one or more parent a Permanent Resident? *

Yes No
Regina Catholic Schools personnel will contact you to discuss further documentation needed.
First language spoken at home: *

English French Other
Second language spoken at home: *

English French No second language Other
Regina Catholic Schools personnel will contact you to discuss supports your child may need for a successful transition into our school.
PROPERTY TAX INFORMATION
Property Tax support: *

Home Owner Renter
Please indicate Property Tax support:

Separate Public Split Unknown
RELIGION INFORMATION
Father religion: *
If no religion, type "NONE
Mother religion: *
If no religion type "NONE"
Student religion: *
If no religion type "NONE"
Parish: *
If no parish type "NONE
Is the student baptized Catholic? *

Yes No
Date of baptism:

Month Day Year
Date
Parish the student was baptized:
PROGRAM INFORMATION
Does your child receive support from: (check all that apply) *

Speech and Language Pathologist Early Child Intervention Program (ECIP) KidsFirst Wascana Rehabilitation Children's Programs Social Services Occupational Therapist Early Childhood Psychologist Autism Resource Centre Child and Youth Services/Regina None of the Above
Other outside agencies not listed
HEALTH INFORMATION
Medical notes:
PRIMARY CONTACT INFORMATION
First name: *
Last name: *
Preferred name: *
Name Used
Relationship: *

Father Mother Stepfather Stepmother Grandparent Guardian Other
*

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

Father Mother Stepfather Stepmother Grandparent Guardian Other
Lives with Student Does not live with Student
Cell phone number:
(including area code)
Work phone number:
(including area code)
Home phone number:
(including area code)
Address (if different than student):
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)
Address:

Street Address

Street Address Line 2

City

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

Month Day Year
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.)

FOR SCHOOL OFFICE USE ONLY
How was the student’s name and birthdate verified?

____ Birth Certificate ____ Baptismal Certificate

____ Saskatchewan Health Services Card

____ Passport ____ Immigration Papers

____ Other _____________________________

Ministry Number: __________________

Signature of person verifying document:

______________________________________________
Should be Empty:

STUDENT INFORMATION

INDIGENOUS SELF DECLARATION (VOLUNTARY)

HERITAGE INFORMATION

PROPERTY TAX INFORMATION

RELIGION INFORMATION

PROGRAM INFORMATION

HEALTH INFORMATION

PRIMARY CONTACT INFORMATION

ADDITIONAL PRIMARY CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

CHILD CARE INFORMATION

ADDITIONAL INFORMATION