Pre-K Application Form

Pre-K Application
Select the school year you are applying for: *
School Receiving Application *
STUDENT INFORMATION
Student First Name as per Birth Certificate *
First Name as per Birth Certificate
Student Middle Name as per Birth Certificate
Middle Name as per Birth Certificate
Student Last Name as per Birth Certificate *
Last Name as per Birth Certificate
Student Preferred Name *
Name Used
Date of Birth *

Month Day Year
Date
Gender *

Male Female Unspecified
House/Apt # or Box # *
Street Name *
Student Land Location (if no civic address) *
City *
Postal Code *
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
Citizenship *

Canada Other
Country of Birth *

Canada Other
Country of Origin *

Canada Other
1st Language *

English French Other
2nd Language *

English French No 2nd Language Other
Property Tax Support *

Home Owner Renter
Please indicate property tax support

Separate Public Split Unknown
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
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
Previous School (if applicable)
Previous School Address (if applicable)
Health Information
Saskatchewan Health Services Card # *
Medical Notes
Primary Contact Information
Legal First Name *
Legal 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
Legal First Name
Legal 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
Work Phone Number
Home Phone Number
Address (if different than student)
Email Address *
*Emergency Contact

*In the event the school cannot get in touch with a primary contact
Emergency Contact First Name *
Emergency Contact 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
Name of Licensed Day Care/Pre-School/Playschool or Babysitter *
Phone Number (including area code)
Area code and number
Address

Street Address

Street Address Line 2

City

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

Month Day Year
Date
Relationship *
*

I understand that in addition to filling out this online form I must also forward to the school or attach below, a copy of my child’s Birth Certificate, Saskatchewan Health Card, Baptism Certificate (if applicable) and Citizenship Documents (if applicable).
If you are using a mobile device, take photos of the documents by clicking here:
Or, if you are using a computer, attach copies of the documents here. (Note: documents must be in PNG file format.)

Cancel of
Should be Empty:

STUDENT INFORMATION

Health Information

Primary Contact Information

Additional Primary Contact Information

*Emergency Contact

Child Care