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Registration

Registration

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Published by: api-3813790 on Oct 17, 2008
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03/18/2014

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Our Lady of Lourdes Elementary School
2547 Hebert Road, Westbank, BC V4T 2J6
Phone: (250) 768-9008 Fax: (250) 768-0168
REGISTRATION PACKAGE
Dear Parents/Guardians,

At Our Lady of Lourdes Catholic Elementary School, your child will receive an outstanding academic foundation as well as a solid moral and spiritual foundation from people who share your values. Our school facility is fully equipped including a computer lab, library, gymnasium and adventure playground. Not only do we offer a quality education meeting the Ministry of Education requirements but we also provide numerous extra-curricular programs for our students in sports, fine arts, and clubs.

Students will be accepted to Our Lady of Lourdes Elementary School based on the Catholic Independent School Nelson Diocesan Admission Policy. Please complete all the necessary forms with appropriate data, documents, and registration fees and return to the school office for processing. Once your application has been processed you will be notified as to the status of your registration. Should you require more information regarding the school, programs, and tuition structure please contact the office to set up an appointment. School tours can also be given upon request.

Sincerely,
Mary T. Manton
Principal
The following documents are required to be submitted with your registration package;
For Office Use only
Received
Initial
Comments

Registration Fee
Method of Payment
Student Activity Fee

$30.00 K
$40.00 Gr. 1 - 7
Parent Participation Fee $100.00
Parent Participation Form
Birth Certificate
Baptism Certificate

Legal Citizenship Form
Family Statement of Commitment
Consent to Travel
Immunization Forms
Care Card #

2547 Hebert Road
Westbank BC V4T 2J6
Phone: (250) 768-9008
Fax: (250) 768-0168
Application for Registration- Year_____________________
Date______________
*Please fill out all lines of information
For office use only
Referred by:__________________
Student ID #____________
LEGAL LAST NAME:__________________
LEGAL GIVEN NAME:_____________________
First and Middle Names
SEX
M / F
GRADE IN SEPTEMBER:___________ BIRTHDATE:_______________
BIRTH PLACE:______________ FORMER SCHOOL:________________ LANGUAGE AT HOME:__________
City, Province, Country
MAIL NAME:________________________ADDRESS:____________________________________________
CITY/PROVINCE:____________________POSTAL CODE:______________ HOME PHONE:______________

MOTHER\u2019S NAME:___________________WORKPLACE:__________________WORK NUMBER:___________
CELL NUMBER:_____________________EMAIL:________________________
CITIZENSHIP STATUS: Canadian Citizen:___

Landed Immigrant:___ Other:___

FATHER\u2019S NAME:___________________WORKPLACE:__________________WORK NUMBER:___________
CELL NUMBER:_____________________EMAIL:________________________
CITIZENSHIP STATUS: Canadian Citizen:___

Landed Immigrant:___ Other:___
ALTERNATE PERSON TO CONTACT IN CASE OF EMERGENCY:_____________________________________
RELATIONSHIP TO CHILD:______________________ PHONE:__________________CELL:______________
FAMILY DOCTOR:___________________ PHONE:_____________ CARE CARD NUMBER:_______________
PLEASE LIST ANY MEDICAL/ BEHAVIOURAL/ LEARNING NEEDS THE SCHOOL SHOULD BE AWARE OF:
_______________________________________________________________________________________
LEGAL RESTRICTIONS: Please provide copies of documentation, if applicable:__ ___ __ __ __ __ __ __ __ __ __ _
_______________________________________________________________________________________
CHILDS RELIGION:_________________ FATHER\u2019S:___________________ MOTHER\u2019S:_________________
PARISH/ CHURCH:______________________________ Envelope #:_______________
Inclusion of a envelope # entitles family to Parish Member tuition rate

SIBLINGS (NOT YET ATTENDING ELEMENTARY SCHOOL)
NAME:_________________BIRTH YEAR:_______ NAME:______________________ BIRTH YEAR:_______
NAME:_________________BIRTH YEAR:_______ NAME:______________________ BIRTH YEAR:_______

ITEMS TO ACCOMPANY REGISTRATION FORM OFFICE WILL MAKE PHOTOCOPIES IF NEEDED:
______$25 REGISTRATION FEE (ONE TIME FEE PER FAMILY)
______$100 PARENT PARTICIPATION FEE PER FAMILY
______TUTION PAYMENT
_______ Post dated cheques for the first of the month
_______ VOID cheque for Auto-debit first of the month
_______ Annual/ Semi Annual Payment (5% discount)
______STUDENT ACTIVITY FEE ($30 for Kindergarten, $40 Gr.\u2019s 1-7)
______BIRTH CERTIFICATE
_____Student
_____Parent
______BAPTISM CERTIFICATE
DATE OF BAPTISM:_________________ CHURCH:_____________
______FIRST COMMUNION
DATE OF FIRST COMMUNION:________ CHURCH:_____________
______IMMUNIZATION RECORD
______FAMILY STATEMENT OF COMMITMENT
______PARENT PARTICIPATION COMMITMENT FORM
______FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT FORM
______LEGAL RESIDENCY
______STUDENT TRAVEL
I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT:
Signature of Parent/Guardian:
Date:
Our Lady of Lourdes
Elementary School
2547 Hebert Road
Westbank BC V4T 2J6
Phone: (250) 768-9008
Fax: (250) 768-0168
Our Lady of Lourdes
Elementary School
Consent Form for Student Registration Form

I consent to having Our Lady of Lourdes Elementary School collect personal information that may include student identification information, birth certificate, legal guardianship, court orders if applicable, parents\u2019 work numbers and e mail address, behavioural, academic and health information, most recent report card, emergency contact name and number, doctor\u2019s name and number, health insurance number and any similar information needed for registration.

I further consent to the use and disclosure of information contained in this form and otherwise collected by or on behalf of Our Lady of Lourdes Elementary School (1) for the purpose of establishing, maintaining, and ending the student\u2019s or parent\u2019s relationship with Our Lady of

Lourdes Elementary School, (2) for additional purposes identified when or before personal
information is collected, and (3) as otherwise provided in Our Lady of Lourdes Elementary
School\u2019s Personal Information Privacy Policy, a copy of which is available on request. I also consent
to the collection, use and disclosure of such personal information by and to agents, contractors and
service providers of Our Lady of Lourdes Elementary School.

This information isrequi r ed in order to register your child at this school and assist the school authority in making an informed decision as to your child\u2019s suitability and appropriate placement in the school. It will also allow the school to respond immediately to an emergency. For more information, the privacy officer for Our Lady of Lourdes Elementary School is Mary T. Manton and may be reached at 250-768-9008

Signature:_ ___ __ ___ ___ _ ____ ___ ___ _ Date:___ __ ____ ___ ___ __ ___ _
Name:______________________________________________________
FAMILY STATEMENT OF COMMITMENT
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
Please sign this copy. Keep the opposite page for your records.

I have read and understood the \u201cFamily Statement of Commitment\u201d and I hereby accept them as stated.
Child's(ren's) Name_ _ _ __ _ ___ _ _ _ __ _ __ _ _ __ _ __ _ _ __ _ __ __ _ _ _ __ _ __ _ _ __ _ __ _ _ __ _ __ __ _ _ _ __ _ _
Parent/Guardian (please print)______________________________________________________
Signature:

______________________________________
Date: ____________________

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