CBA Registration Form 2023/2024

1
1st Student Legal Name* This field is required.
Student Last Name
Student First Name
2
What grade will your 1st student be attending? Choose one.* This field is required.
Senior Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
3
Gender of 1st student* This field is required.
Male
Female
4
Birthdate of 1st student* This field is required.
Date
Year
Month
Day
5
How old will the 1st student be on September 1st of this year?* This field is required.
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
13 years old
14 years old
15 years old
6
Mother* This field is required.
Mother First Name
Mother Last Name
7
Mother's Main Phone Number* This field is required.
Please enter a valid phone number.
8
Mother's Email* This field is required.
example@example.com
Confirm Email
9
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Mother's Employer/Occupation
11
Father
Father First Name
Father Last Name
12
Father's Main Phone Number
Please enter a valid phone number.
13
Father's Email
example@example.com
Confirm Email
14
Do you have the same address as mother?
YESNO
15
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
16
Father's Employer/Occupation
17
1st Emergency Contact Person* This field is required.
1st Emerg. First Name
1st Emerg. Last Name
18
Emergency Phone Number* This field is required.
Please enter a valid phone number.
19
What is the relationship to the student(s)?* This field is required.
20
2nd Emergency Contact Person* This field is required.
2nd Emerg. First Name
2nd Emerg. Last Name
21
2nd Emergency Phone Number* This field is required.
Please enter a valid phone number.
22
What is the relationship to the student(s)?* This field is required.
23
Who has legal custody of your 1st student?* This field is required.
father
mother
shared
24
Whom does your 1st student live with?* This field is required.
both parents
father only
mother only
alternates between parents
25
Is either parent's access to this student limited by court order? If yes, attach documents at end of registration.* This field is required.
YESNO
26
Has your 1st student attended another school?* This field is required.
YESNO
27
What was the name and address of the last school attended?
28
What grade was your 1st student in before leaving the school?
Please Select
Please Select
SK
1
2
3
4
5
6
7
8
29
Please indicate the reason your 1st student left the previous school.
30
Who should we contact first for emergencies?* This field is required.
mom
dad
use emergency contact info
31
Who should we contact first for attendance?* This field is required.
mom
dad
32
Should separate correspondance/reports be sent to each parent?* This field is required.
YESNO
33
Does your 1st student have any medical conditions/allergies we need to know about?* This field is required.
YESNO
34
List medical conditions/allergies of your 1st student.Use your own words to describe if you do not know the medical term.
35
Does your 1st student need to take medication during the school day?* This field is required.
YESNO
36
List of medication student will take at school. Medication authorization form to be filled out in office and secretary will dispense medication.
37
Does your 1st student have any serious allergies requiring the use of an epipen.* This field is required.
YESNO
38
Has your 1st student been instructed on the proper administration of the epipen?
YESNO
39
Does your 1st student have any medical condition that requires changes in any of the child's classes including gym and field trips?* This field is required.
YESNO
40
Please indicate what changes are necessary for your student's success.
Huge
Large
Normal
Small
Ok
Ok
41
Has your 1st student ever been tested or diagnosed with a learning exceptionality or other educational special needs? If yes, please indicate below.* This field is required.(enter none if no exceptionality)
42
Has your 1st student ever required remedial tutoring or special educational services. If yes, please describe below.* This field is required.(enter none if no extra services)
43
Do you have additional children to register?
YESNO
44
2nd Student's Legal Name* This field is required.
Student Last Name
Student First Name
45
Gender of 2nd Student* This field is required.
Male
Female
46
Birthdate of your 2nd Student* This field is required.
Date
Year
Month
Day
47
How old will your 2nd student be on September 1st of this year?* This field is required.
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
13 years old
14 years old
15 years old
48
What grade will your 2nd student be attending? Choose one.* This field is required.
Junior Kindergarten
Senior Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
49
Who has legal custody of your 2nd student?* This field is required.
father
mother
shared
50
Whom does your 2nd student live with?* This field is required.
both parents
father only
mother only
alternates between parents
51
Is either parent's access to student limited by court order? If yes, attach documents at end of registration.* This field is required.
YESNO
52
Has your 2nd student attended another school?* This field is required.
YESNO
53
What was the name and address of the last school attended?
54
What grade was your 2nd student before leaving the school?
Please Select
Please Select
SK
1
2
3
4
5
6
7
8
55
Please indicate the reason your 2nd child left the previous school.
56
Who should we contact first for emergencies?* This field is required.
mom
dad
use emergency contact info
57
Who should we contact for attendance?* This field is required.
mom
dad
58
Should separate correspondance/reports be sent to each parent?* This field is required.
YESNO
59
Does your 2nd student have any medical conditions we need to know about?* This field is required.
YESNO
60
List Medical Conditions of your 2nd student.Use your own words to describe if you do not know the medical term.
61
Does your 2nd student need to take medication during the school day?Medication authorization form to be filled out in office and secretary will dispense medication.
YESNO
62
List of medicine used for your 2nd student.Must be copied from the original container from the pharmacy.
63
Does your 2nd student have any serious allergies requiring the use of an epipen.
YESNO
64
Has your 2nd student been instructed on the proper administration of the epipen?
YESNO
65
Does your 2nd student have any medical condition that requires changes in any of the child's classes including gym and field trips?
YESNO
66
Please indicate what changes are necessary for your student's success.
Huge
Large
Normal
Small
Ok
Ok
67
Has your 2nd student ever been tested or diagnosed with a learning exceptionality or other educational special needs? If yes, please indicate below.* This field is required.(enter none if no exceptionality)
68
Has your 2nd student ever required remedial tutoring or special educational services. If yes, please describe below.* This field is required.(enter none if no special special services)
69
Do you have additional children to register?
YESNO
70
3rd Student's Legal Name* This field is required.
Student Last Name
Student First Name
71
Gender of 3rd Student* This field is required.
Male
Female
72
Birthdate of your 3rd Student* This field is required.
Date
Year
Month
Day
73
How old will your 3rd student be on September 1st of this year?* This field is required.
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
13 years old
14 years old
15 years old
74
What grade will your 3rd student be attending? Choose one.* This field is required.
Junior Kindergarten
Senior Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
75
Who has legal custody of your 3rd student?* This field is required.
father
mother
shared
76
Whom does your 3rd student live with?* This field is required.
both parents
father only
mother only
alternates between parents
77
Is either parent's access to student limited by court order? If yes, attach documents at end of registration.* This field is required.
YESNO
78
Has your 3rd student attended another school?* This field is required.
YESNO
79
What was the name and address of the last school attended?
80
What grade was your 3rd student before leaving the school?
Please Select
Please Select
SK
1
2
3
4
5
6
7
8
81
Please indicate the reason your 3rd child left the previous school.
82
Who should we contact first for emergencies?* This field is required.
mom
dad
use emergency contact info
83
Who should we contact first for attendance?* This field is required.
mom
dad
84
Should separate correspondance/reports be sent to each parent?* This field is required.
YESNO
85
Does your 3rd student have any medical concerns/allergies we need to know about?* This field is required.
YESNO
86
List of medical concerns/allergies of your 3rd student.Use your own words to describe if you do not know the medical term.
87
Does your 3rd student need to take any medication at school?* This field is required.Medication authorization form to be filled out in office and secretary will dispense medication.
YESNO
88
List of medicine used for your 3rd student.Must be copied from the original container from the pharmacy.
89
Does your 3rd student have any serious allergies requiring the use of an epipen.* This field is required.
YESNO
90
Has your 3rd student been instructed on the proper administration of the epipen?
YESNO
91
Does your 3rd student have any medical condition that requires changes in any of the child's classes including gym and field trips?* This field is required.
YESNO
92
Please indicate what changes are necessary for your student's success.
Huge
Large
Normal
Small
Ok
Ok
93
Has your 3rd student ever been tested or diagnosed with a learning exceptionality or other educational special needs? If yes, please indicate below.* This field is required.(enter none if no exceptionality)
94
Has your 3rd student ever required remedial tutoring or special educational services. If yes, please describe below.* This field is required.(enter none if no special services)
95
Do you have additional children to register?
YESNO
96
4th Student's Legal Name* This field is required.
Student Last Name
Student First Name
97
Gender of your 4th Student* This field is required.
Male
Female
98
Birthdate of your 4th Student* This field is required.
Date
Year
Month
Day
99
How old will your 4th student be on September 1st of this year?* This field is required.
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
13 years old
14 years old
15 years old
100
What grade will your 4th student be attending? Choose one.* This field is required.
Junior Kindergarten
Senior Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
101
Who has legal custody of your 4th student?* This field is required.
father
mother
shared
102
Whom does your 4th student live with?* This field is required.
both parents
father only
mother only
alternates between parents
103
Is either parent's access to student limited by court order? If yes, attach documents at end of registration.* This field is required.
YESNO
104
Has your 4th student attended another school?* This field is required.
YESNO
105
What was the name and address of the last school attended?
106
What grade was your 4th student before leaving the school?
Please Select
Please Select
SK
1
2
3
4
5
6
7
8
107
Please indicate the reason your 4th child left the previous school.
108
Who should we contact first for emergencies?* This field is required.
mom
dad
use emergency contact info
109
Who should we contact first for attendance?* This field is required.
mom
dad
110
Should separate correspondance/reports be sent to each parent?* This field is required.
YESNO
111
Does your 4th student have any medical conditions/allergies we need to know about?* This field is required.
YESNO
112
List medical conditions/allergies of your 4th student.Use your own words to describe if you do not know the medical term.
113
Does your 4th student need to take medication at school?* This field is required.Medication authorization form to be filled out in office and secretary will dispense medication
YESNO
114
List of medicine used for your 4th student.Must be copied from the orginal container from the pharmacy..
115
Does your 4th student have any serious allergies requiring the use of an epipen.* This field is required.
YESNO
116
Has your 4th student been instructed on the proper administration of the epipen?
YESNO
117
Does your 4th student have any medical condition that requires changes in any of the child's classes including gym and field trips?* This field is required.
YESNO
118
Please indicate what changes are necessary for your student's success.
Huge
Large
Normal
Small
Ok
Ok
119
Has your 4th student ever been tested or diagnosed with a learning exceptionality or other educational special needs? If yes, please indicate below.* This field is required.(enter none if no exceptionality)
120
Has your 4th student ever required remedial tutoring or special educational services. If yes, please describe below.* This field is required.(enter none if no special services)
121
I acknowledge and confirm that I and my/our child/ren have read and agree to all the policies in the CBA Parent/Student Handbook located on the CBA website.* This field is required.
YESNO
122
Are you willing to volunteer at CBA for events or during school hours?* This field is required.
mother
father
neither
both
123
Are you willing to allow your contact information to be shared with the CBA community?(Student name and grade will be included)
YESNO
124
Please indicate which information we can share.
Mother Name
Father Name
Mother phone
Father phone
Mother email
Father email
125
Please indicate if we have your permission to photograph your student(s).* This field is required.
YESNO
126
Is the child an International Student?* This field is required.
YESNO
127
For international students, the following financial obligations need to be processed before the registration is considered complete. Please indicate if these are done.
Application Fee of $2,000.00 per family per year.
Registration Fee of $150.00 per child: cheque or use etransfer at cbagiving@cbcbrantford.ca
Pre-authorized payment or 12 post-dated cheques for tuition, dated the first of each month beginning in July prior to the start of the current academic year.
128
Application Fee of $100.00 paid (new families only - one-time fee)* This field is required.(cheque or etransfer to cbagiving@cbcbrantford.ca)
YESNO
129
Annual Registration Fee paid for New and Returning Students of $150.00 per child* This field is required.(cheque or etransfer at cbagiving@cbcbrantford.ca)
YESNO
130
Choose your tuition payment plan option.* This field is required.
Preauthorized payment
12 Post dated cheques
Prepay full amount
other
131
Post dated cheques are to be dated the first of each month beginning in July prior to start of current academic year.

Our school office will be in touch to confirm your 'other' payment option.
132
Upload Image of " VOID" cheque or Pre-Authorized Payment FormClick on "SAVE" button if satisfied with image of VOIDED Check
133
Days Overdue

30 days

Interest will be added to the account retroactive to the date the account became past due at the rate of 1% per month.

45 days

Written past due notice issued from CBA office

60 days

The parents will be required to remove their child(ren) from CBA until the account is brought current.

Should there be a financial difficulty, or you are in need of assistance, please call the Academy Office, 519-754-4806, as soon as possible to resolve the matter. It is our desire that your child’s education will continue unaffected.
134
File UploadUpload new student files: Birth Certificate, court/custody documents. Please bring in documents to office if you encounter difficulty uploading documents.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
135
Signature of Parent/Guardian* This field is required.
Clear
136
Second Signature (if required)
137
Form completed on the date indicated below.
Date
Year
Month
Day
Should be Empty: