Student Information:
Student Name:
Name used (if different than legal name):
Enrolled in which program?
Gender: Male Female
Birth date:
Age:
Home Phone:
Address:
Sask. Health #:
Guardian Information:
Parent/Guardian A
Name:
Address (if different):
Phone #(home/cell):
Work #:
E-mail:
Parent/Guardian B
Child resides with:
Caregiver Information
Daytime phone:
Emergency Contact:
Emergency Phone:
Collection of the information pertaining to the next section is mandated by Saskatchewan Learning and its use and disclosure is protected under Saskatchewan’s Local Authority Freedom of Information and Protection of Privacy Act.
Country of Birth:
Country of Citizenship:
First Language spoken at home:
Second Language spoken at home:
In which school division do parents/guardians reside? Regina Public Schools Other
If Other, please specify:
Are you Aboriginal (Aboriginal people are those who identify themselves to be Registered/Treaty/Status Indian, non-Status Indian, Métis, or Inuit)? Yes No
If yes, please specify the Aboriginal group you belong to: Registered/Treaty/Status Indian Non-status Indian Métis Inuit Band Affiliation Treaty Status Number
The information requested in the following sections is voluntary. The purpose of its collection and use is to provide the best learning environment for your child(ren), and to ensure his/her safety. It will be treated confidentially according to the Local Authority Freedom of Information and Protection of Privacy Act.
Sibling Information
Sibling Names:
Sibling Ages:
Sibling Schools:
Medical History
Does your child have any medical history or conditions that we should know about in terms of his/her health or the health of the other children (e.g., allergies, eczema, epilepsy, seizures, etc.):
Health Issues:
Level of Urgency:
Medication:
What should we do?:
Immunizations History: (Please note that we recognize that immunizations are a choice and admission to the school will not be determined by this answer).
Are your child’s immunizations up to date? Yes No
Intellectual/Social Development
Does your child have any cognitive special needs? If so, please specify the need, special equipment required or used, and a diagnosis if available).
By which method(s) does your child learn best? Aurally (listening to someone speak) Visually (through gestures, pictures, seeing someone do it through modeling) Kinesthetically (physically showing knowledge or by doing, experientially) Musically (listening to music, making up songs) Naturalistically (Being in nature)
Please list some of your child’s favourite activities or past times:
What do you and your child like to do together?
What are your child’s gifts and strengths?
What does your child find challenging?
What are your hopes and dreams for your child as a student of Prairie Sky School? What do you want your child to learn at Prairie Sky School?
Is there any additional information that would be helpful to teachers regarding any area of your child’s development?
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