Form 501.

1A(a)

STUDENT REGISTRATION FORM

The information on this form is collected under the authority of the School Act. Information is used for Ministry of
Education reporting: demographic, enrolment, budget, facility, transportation and operational analyses. It will be
kept secure and confidential, in accordance with the Freedom of Information and Protection of Privacy Act.

For Office Use Only

Date of Registration (mm/dd/yyyy): January 23rd 2024 Time of Registration (am/pm): 8am
Out of Catchment Form Completed:
Catchment School: Ecole Squamish Elementary
☐ Yes ☐ No
Current Grade: Kindergarten Start date (mm/dd/yyyy): 09/03/2024 PEN:

☐ Requested School Records
☐ Demographics Printed/Added to
Office Student Info Binder
☐ Program Assignments (for mid- year
student entries)
☐ Copy of Proof of Birthdate On File
☐ Printed Name Tag For Classroom
Emergency Kit (Elementary)
☐ French Immersion
☐ Local ID# to Tech Dept. & Library
☐ FIPPA Web 2.0 Tools
☐ Immunization Record

Required Registration Documentation

Before registering your child, the school must have all of the following documentation.

☐ Child’s Birth Certificate or Passport ☐ Health Care Card ☐ Proof of street address*

*Parent Driver’s License, BC Identification, utility bill, or residential rental/lease agreement, with parent name
and street address

Student Information

Please ensure you fill this form out completely using N/A for areas that are not applicable.

Grade: Kindergarten Program Desired: ☐ English ☐ French Immersion

☐ Cultural Journeys/Learning Expeditions

Legal Names as shown on birth certificate

Surname Green First Name: Walter

Birthdate (DD/MM/YYYY): 05/11/2019

Middle Name: William Alexander

Gender: Primary Language(s) spoken at home: English

M

Re: Policy 501 Student Registration, Enrolment and Placement 1

 Form 501.1A(a)

Usual Names (if different from legal names)

Usual Surname: N/A Usual First Name: N/A

Home Phone: 778-266-1114 Street Address: 38397 Buckley Ave

(House #, Street Name)

Apt#: Box #: 32 City: Squamish Postal Code: V8B 0A1

3

Names of School Aged Siblings:

N/A

Previous School Information

School name: Grade: ☐ Attended English Program

N/A N/A
☐ Attended French Immersion Program

City Province: Phone Number:

N/A N/A N/A

Citizenship

☐ Canadian ☐ Other Citizenship (provide details below)

☐ Landed Immigrant ☐ Permanent Resident ☐ International Student ☐ Study/Work Permit

Country of Birth: Canada Country of Citizenship: Canadian

Medical Information

Allergies: None

Medical Condition: None

If you answered yes to either of the above questions please see the principal regarding an Individual Care
Plan.

Does your child carry/require medication at school? ☐ No ☐ Yes

If yes, medication name and additional information:

N/A

Re: Policy 501 Student Registration, Enrolment and Placement 2

 Form 501.1A(a)

Care Card Number:

9706059069

Doctor: Phone: 604-892-3535

Dr. James Jamieson

Family Information

Student lives with: ☐ Both Parents ☐ Joint Custody (Court order documents required for student file)
☐ Sole custody ☐ Other (describe)

Parent/Guardian #1
(circle one) Mother, Step-mother, Foster-mother, Grandmother, Guardian, Father, Step-father, Foster-father,
Grandfather, Guardian
First Name: Katrina-Marie Last Name: Lowe

Home Phone: Cell phone: 778-266-1114

778-266-1114

Work Phone: Email Address: klowe@sd48.bc.ca

604-932-5321

Address/Home Phone No. Place of Work:

Myrtle Philip Community School
☐ Same as child ☐ Different (Fill Below)

Street Address: Apt #: Box #:

(House #, Street Name)

City: Postal Code:

Parent/Guardian #2
(circle one) Mother, Step-mother, Foster-mother, Grandmother, Guardian, Father, Step-father, Foster-father,
Grandfather, Guardian
First Name: Joshua Last Name: Green

Home Phone: Cell phone: 604-848-9523

604-848-9523

Work Phone: Email Address: squamishlife@outlook.com

Address/Home Phone No. Place of Work:

BCMEA: Squamish Terminals
☐ Same as child ☐ Different (Fill Below)

Street Address: Apt #: Box #:

(House #, Street Name)

City: Postal Code:

Re: Policy 501 Student Registration, Enrolment and Placement 3

 Form 501.1A(a)

Indigenous Ancestry

If any of the following applies to your child they have Indigenous Ancestry and are eligible for our Indigenous
Education programs and services. Please check all that apply below.
☐ First Nations ☐ Metis ☐ Inuit

Is your child: ☐ Non-status ☐ Status-Off Reserve ☐ Status-On Reserve

DIA #:

Name of Band: Mohawks of the Bay of Quinte Band number: 164

☐ None of the above applies to my child.

Emergency Contacts

In the event your child is ill or there is an emergency, we will attempt to contact you prior to calling emergency
contacts listed below. Please do not list yourself as an emergency contact, but rather provide us with the
names of other friends or family who you authorize to pick up your child in the event of an emergency or illness.

1. Legal Name: Katrina Lowe Relationship to student: Mother

Home Phone: Cell Phone: 778-266-1114

2. Legal Name: Joshua Green Relationship to student: Father

Home Phone: Cell Phone:

604-848-9523

3. Legal Name: April Lowe Relationship to student:

Grandmother

Home Phone: Cell Phone:

604-848-4446

If possible, please make contact 4 out of district

4. Legal Name: Thomas Lowe Relationship to student: Uncle

Home Phone: Cell Phone: 250-319-9238

I certify that the information I have provided on this form is correct.

Parent/Guardian Signature Date

Re: Policy 501 Student Registration, Enrolment and Placement 4

 Form 706.1A(a)

CANADIAN ANTI-SPAM LEGISLATION CONSENT FORM

STUDENT INFORMATION SCHOOL INFORMATION
Last Name: School:
Green Ecole Squamish Elementary

First Name: Grade:

Walter Kindergarten

Canada's Anti-Spam Legislation (CASL) came into effect July 1, 2014. All school districts are required to obtain
consent to send newsletters, announcements, and other electronic messages which may contain advertising or
promotions including requests for field trips, fundraising, yearbooks, student pictures, dance tickets, or other
similar events and offers.

Please review, sign and return this form to your child’s school as soon as possible . If you have any questions about
the information requested below, please contact School District No. 48 Information and Privacy Officer, Danielle
Haverstock, Secretary-Treasurer, dhaverstock@sd48.bc.ca.

PLEASE CHECK ONE:

❏ I CONSENT to School District No. 48 contacting me using electronic messages which may include
commercial information as described above.
❏ I DO NOT CONSENT to School District No. 48 contacting me using electronic messages.

PLEASE CHECK ONE:

❏ I also CONSENT to the school Parent Advisory Council and the District Parent Advisory Council to contact me
using electronic messages which may include commercial information as described above.
❏ DO NOT CONSENT to the school Parent Advisory Council and the District Parent Advisory Council to contact
me using electronic messages.

Parent/Guardian Name: ________________________ __________________________

(Last) (First)

Parent/Guardian Signature: ________________________

Date: _________________________

Other: squamishlife@outlool.com
Preferred Email Address: klowe@sd48.bc.ca

You may also subscribe or unsubscribe from this communication list at any time by contacting the school.

Re: Operational Policy 706 Acceptable Use of Information and Communications Technology 1
Date Amended: August 12, 2020
 Form 706.1A(d)

G SUITE CONSENT FORM

Student account information (student first and last name and grade level), as well as any documents uploaded
onto the Google Apps platform will be stored on secure Google servers located beyond Canada, and may be
subject to the laws of foreign jurisdictions. Privacy legislation requires that we inform you of this and obtain your
consent to this arrangement.

The following G Suite services apply:

• Google Drive (unlimited storage, including Docs, Sheets, Slides, Forms, and Drawing)
• Ability to share data is set to private by default
• Google Drive is limited sharing to only School District No. 48 domains
• Google Calendar, Google Sites, and Google Classroom
• Additional Google Services: Google Maps, Google Books, YouTube (filters on), Chrome Web Store, Fusion
Tables, Google Bookmarks, Google Earth, and other approved SD48 google applications deemed
necessary for student learning

PLEASE CHOOSE ONE

☐ I have discussed the above-mentioned information with my child and permit my child to access School
District No. 48 G Suite account for purposes described above. I also understand that additional Google
services and/or applications may be included and used for the purposes described above.

☐ I have discussed the above-mentioned information with my child and DO NOT permit my child to access
School District No. 48 G Suite account for purposes described above, including any additional Google
services and/or applications that may be included and used for the purposes described above.

I have read this consent form and understand that my child’s personal information will be used for G-Suite (GAFE),
which may include:
• First and last name, and grade level
• Classroom assignments, research notes, presentations, school-based projects, portfolios, websites
• Multimedia objects created by students (e.g. videos, pictures, audio files, animations, etc.)
• Summative and formative assessments (e.g. teacher comments, peer feedback, surveys, grades, etc.)
• Communication with teachers and other students related to educational purposes
• Any material related to the educational purposes

This consent will be considered valid from the date at which it is signed until the student’s transition to another
school or when permission has been explicitly withdrawn.

Green
Student Name: Walter (First)
(Last)

Student Grade: Kindergarten

STUDENT SIGNATURE: ________________________ DATE: _____________________________

PARENT/GUARDIAN SIGNATURE: ________________________ DATE: _____________________

Re: Board Policy 706 Acceptable Use of Information and Communications Technology 1
Date Amended: August 12, 2020