Holden Rural Academy Registration Form

Holden Rural Academy Registration Form
Please read before completing the registration form.

This registration form is a legal document. Before a student can be registered by a school, this form must be completed in its entirety and signed by the parent or legal guardian. This form is used to enroll a student who is new to the Holden Rural Academy.

In addition to the completed registration form, the following supporting documents will be requested after commencement has been granted to the Holden Rural Academy: !Legal proof of student’s name and birth date (e.g., Canadian provincial birth certificate, Canadian citizenship certificate, passport, student visa) !Verification of residency: document showing parent/guardian name and local address (e.g. driver’s license, utility bill, home insurance, property tax bill) Additional legal documentation may be required to confirm student enrollment

This form can be downloaded from holdenruralacademy.ca/registrationform
Confirmation of Registration Submission:

Upon submission of the registration package, Holden Rural Academy will review the documents and contact you to inform you of your child’s confirmed enrolment or if additional supporting documentation is required.
Student Registration Form for School Year: 2022/2023
FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT (FOIP) The personal information collected on this form is part of the registration process and is authorized under the provisions of the Education Act and its regulations and under Section 33(c) of the FOIP Act. All personal information collected during the registration process is kept secure and access is restricted.
Student Information
Legal Last Name
Legal First Name
Legal Middle Name
Preferred Last Name
Preferred First Name
Date Registering

Month Day Year
Date
Grade Entering
Alberta Education ID# (if known)
Birth Date (MM/DD/YYYY)

Month Day Year
Date
Age as of Sept 1, 2022:
years
months
Gender

Female Male Prefer not to disclose Other
Mailing Address
Village/Town
Postal Code
Physical Address:

Same as Mailing Address Street Address
Street address
Rural 911 address (blue sign)
Legal Land Description

NE NW SE SW
Section
Township
Range
Meridian
Student’s Cell: (optional)
Student’s Email: (optional)
example@example.com
Transportation:
Does this student require bussing?

Yes (Families Requiring bussing will be sent a follow up email) No
Citizenship:

(documentation to be submitted after commencement)
Canadian Citizen (Copy of Canadian birth certificate or Canadian citizenship documents) Permanent Resident (Copy of birth certificate and permanent resident Card) Temporary Resident (Copy of study permit or authorization documents) Child of a Canadian Citizen (Copy of birth certificate and parent Canadian birth certificate or Canadian citizenship documents) Child of an Individual Lawfully admitted to Canada (Copy of birth certificate and copy of parent permanent resident card or work or study permit) Stepchild of a Canadian or Temporary foreign Worker (Copy of birth certificate and copy of immigration papers parent and student) Other
Legal Guardian/Parent Information (you may be asked to provide additional legal documentation)

A guardian is defined in section 20 of the Family Law Act, or a guardian appointed under Part 5 of the Child Welfare Act, Part 1, Division 5 of the Child, Youth and Family Enhancement Act or section 23 of the Family Law Act.
Parent/Guardian 1
Relationship to Student (select one)

Mother Father Parent Legal Guardian Other
First Name
Last Name
Title Ms., Mrs., Mr., Dr., etc
Address (if different from Student’s)
Primary Phone Number
Alternate Phone Number
Email (will be used for school communications)
example@example.com
Parent/Guardian 2
Relationship to Student (select one)

Mother Father Parent Legal Guardian Other
First Name
Last Name
Title Ms., Mrs., Mr., Dr., etc
Address (if different from Student’s)
Primary Phone Number
Alternate Phone Number
Email (will be used for school communications)
example@example.com
Student is considered "independent" (over the age of 16 and not living at home)

Yes No
Custody Information
Is there any Court Order affecting access to the student?
Yes (Legal documentation will be required) No
Emergency Contacts
An emergency contact is someone who may be contacted if the student’s parent(s) or guardian(s) listed above are unavailable. Emergency contacts listed below have permission to pick up student from school.
Emergency Contact #1
Relationship to Student
First Name
Last Name
Primary Phone Number
Alternate Phone Number
Emergency Contact #2
Relationship to Student
First Name
Last Name
Primary Phone Number
Alternate Phone Number
Medical Information:
Does this student have any medical conditions of which the school needs to be aware? Please explain
Student Record Information (student records request required)
Name of Last School
Phone Number
City & Province
Education Special Needs
Has this student had any previous special needs testing or assistance?

Yes No
If yes, what supports were provided, be specific?
Additional Enrolment Information
The following questions are asked to aid in program placement and in communication in the event of an emergency
Birth Country, if not Canada
Is English the student’s first (primary) language?
Is English the student's first (primary) language?

Yes No
What language is mainly spoken at home?
Student Protection
An individual may be forbidden contact with the student by way of a legal process. If you have answered yes, the school will collect the required documentation which will be retained on the student’s record.

Please acknowledge if legal documentation exists forbidding an individual(s) from having contact with the student.
Yes No
Francophone Rights
According to the Education Act and section 23 of the Canadian Charter of Rights and Freedoms, a parent or legal guardian who is a Canadian citizen has the right to have his/her children receive school instruction in French. This applies if the parent/ legal guardian is a resident of Alberta and: French was the first language learned, and is still understood, by at least one parent; or, one or more of the parents, or one or more of their children have received, or are receiving instruction in a French first language program or school in Canada (this does not include French immersion program

Do you claim entitlement to a francophone education under the terms of the Education Act?
Yes No
Aboriginal Self-Declaration (Optional)

The Aboriginal self-identification question was informed by the Constitution Act, 1982, section 35(2), in that "Aboriginal peoples" include "Indian, Inuit and Métis." The following question box (updated in June 2016) appears on registration and annual verification forms for public, separate, Francophone, charter, and Level 2 accredited funded private school authorities.

If you wish to identify as an Aboriginal person, please specify
First Nations (status)

First Nations (status) First Nations (non-status) Métis Inuit
For further information, please refer to: www.education.alberta.ca/system-supports/results-reporting or contact Alberta Education at 780-427-8501.
Place-Based Education
Holden Rural Academy is committed to a philosophy of Place-Based Education. Learning will take place in the classroom, as well as off-campus at various venues in the community. Students should expect to walk to these locations in Holden. A detailed information letter and permission forms will be provided before the start of the school year.
Declaration by Parent or Legal Guardian
The information provided in this document is true, correct, and complete. The individuals identified in the “legal guardian/parent” section have the right to view student information and make educational decisions for this child, unless otherwise indicated here and supported with legal documentation.

Further, I recognize that it is my responsibility to notify my child’s school should the above information change.
Printed Name
Date (MM/DD/YYYY)

Month Day Year
Date
Signature

Clear
Place-Based Education Options
We want your input on the Place-Based opportunities that we will set up. We want to find out about each student’s interests and abilities, as well as career paths or trades they would like to explore. Check off the boxes provided, or explain using the blank lines. What we can offer will be determined by interest, enrollment numbers and community partners. Or it may be delayed until the next year.
Student Name
Sports

Hockey Swimming Fitness Training Baseball Golf Basketball Volleyball Other
Fine Arts

Drama Art Photography
Type a question

Fashion (Sewing & Design, Quilting)
Mechanics

HD Automotive Small Engines
Construction

Woodworking Metal Fabrication
Type a question

Culinary Arts
Agriculture

Gardening/Greenhouse Landscaping Livestock/Poultry Crops Green Certificate (16+)
Community Connections

Working with the Elderly Working with Children Volunteer Opportunities Community Christmas Activities
Online Courses

2nd Language Other
For students 16 and older

RAP (Registered Apprenticeship Program Work Experience Green Certificate (Agriculture)
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Holden Rural Academy Registration Form

Student Registration Form for School Year: 2022/2023

Student Information

Transportation:

Citizenship:

Parent/Guardian 1

Parent/Guardian 2

Custody Information

Emergency Contacts

Emergency Contact #1

Emergency Contact #2

Medical Information:

Education Special Needs

Additional Enrolment Information

Student Protection

Francophone Rights

Place-Based Education

Declaration by Parent or Legal Guardian

Place-Based Education Options