JK Registration

1
Student Name* This field is required.
Student Last Name
Student First Name
2
Gender of Student* This field is required.
Please Select
Please Select
Female
Male
3
Student Birthdate* This field is required.
Date
Month
Day
Year
4
How old will your student be on September 1st?* This field is required.
Please Select
Please Select
3 years
4 years
5
Please upload student's birth certificate here:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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6
Mother* This field is required.
Mother's First Name
Mother's Last Name
7
Mother's Main Phone Number* This field is required.
Please enter a valid phone number.
8
Mother's Email Address* This field is required.
example@example.com
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 Address
example@example.com
14
Father's Address is the same as Mother's.
Yes
No
15
Father's 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 Contact Phone Number* This field is required.
Please enter a valid phone number.
19
What is the relationship to the student?* This field is required.
20
2nd Emergency Contact Person* This field is required.
2nd Emerg. First Name
2nd Emerg. Last Name
21
Emergency Contact Phone Number* This field is required.
Please enter a valid phone number.
22
What is the relationship to the student?* This field is required.
23
Who has legal custody of the student?* This field is required.
Mother
Father
Both
24
Whom does the student live with?* This field is required.
Mother only
Father only
Both parents
Alternate between parents
25
Is either parent's access limited by a court order?* This field is required.
Yes
No
26
File Upload
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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27
Who should we contact first for emergencies?* This field is required.
Mother
Father
Use emergency contact info
28
Who should we contact first for attendance?* This field is required.
Mother
Father
29
Should separate correspondance/reports be sent to each parent?* This field is required.
Yes
No
30
Does your student have any medical issues/allergies or use any medication we need to know about?* This field is required.
Yes
No
31
Please indicate medical issues or allergies here.
32
Please indicate medication your student takes during the school day. (All medication is dispensed from the school office. Please see the secretary.)
33
Does your student have any serious allergies requiring the use of an epipen?* This field is required.
Yes
No
34
Has your student been instructed on the proper administration of the epipen?
Yes
No
35
Does your student have any medical condition that requires changes in any of the child's classes including gym or field trips?* This field is required.
Yes
No
36
Please indicate what modifications are required for your student.
37
Has your child received remedial tutoring or special education services?* This field is required.
Yes
No
38
Please describe services provided for your child.
39
Does your child have a medical diagnosis by a professional: Autism Spectrum Disorder, ADHD, Speech Language Delay, Other* This field is required.
Yes
No
40
Please provide more information about your child's diagnosis.
41
Has your child attended daycare?* This field is required.
Yes
No
42
Does your child nap?* This field is required.
Yes
No
43
Can your child zip/button clothes independently?* This field is required.
Yes
No
Some help required
44
Can your child use the bathroom independently?* This field is required.
Yes
No
Some help required
45
Describe your child's social interactions with their peers. * This field is required.
46
Describe your child's interactions with adults (teachers/leaders).
Huge
Large
Normal
Small
Ok
Ok
47
I acknowledge and confirm that I have read, agree with, and reviewed with my child, the policies contained in the CBA Parent/Student Handbook, (including the uniform policy), located on the CBA website.* This field is required.
Yes
No
48
Please indicate if we have permission to photograph your child.* This field is required.
Yes
No
49
Are you willing to volunteer for CBA events or during school hours?
mother
father
neither
both
50
Are you willing to have your name and contact information shared with the CBA community in a directory?
YESNO
51
Do you have older children to register?* This field is required.If yes, please register siblings on the SK - 8 Registration Form. Submit payment options and banking information with that registration.
Yes
No
52
Application Fee of $100 paid (new family fee only - one time fee). Can be paid by cheque or etransfer to cbagiving@cbcbrantford.ca.* This field is required.
Yes
No
Siblings currently attend - does not apply
53
Annual Registration Fee paid for New and Returning Students of $150 per child. Can be paid by cheque or etransfer to cbagiving@cbcbrantford.ca.* This field is required.
Yes
No
54
Choose your tuition payment plan option (forms will be uploaded at the end of registration form)
Preauthorized payment
12 post dated cheques
Payment in full before September 1st
55
12 postdated cheques to be dated the first of each month beginning in July prior to start of current academic year.

The school office will contact you in regards to your 'other' payment option.
56
Please upload your preauthorized payment bank document.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
57

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

Parents will be required to remove their child/ren from CBA until the account is brough 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.
58
Signature of Parent/Guardian. Please sign here to complete your JK registration.
Clear
59
Form completed on this date.
Date
Month
Day
Year
Should be Empty: