BCNEA Student Registation

BIGSTONE CREE NATION EDUCATION AUTHORITY

SCHOOL REGISTRATION FORM
Collection and Use of Personal Information Disclaimer

The information requested on this form is being collected pursuant to the School Act, Section 23, A.R. 71/99 and the FOIP Act, Sections 33(c), 39(1)(b), and 40(1)(c). Information acquired through this form is kept secure and access is restricted. In accordance with the Student Record Regulation, this form will be placed in the student’s record file.

Please contact the school if you have any questions regarding this request for individual student information and about our use or disclosure of student information.
This form is to register your student in a school program at Bigstone Cree Nation Education (BCNEA)

Please make sure you have time to complete this form - it usually takes 10 to 15 minutes to ensure we have all the correct information.

You can UPLOAD important documents to this form to avoid having to bring in originals for us to copy. Documents we require to complete registration include
- PROOF of legal name and age (Usually a birth certificate)
- PROOF of legal Guardianship (if applicable)
- You will be required to enter an Alberta Health Care # for the your student
- If STATUS you will be required to enter the treaty number
You can complete the entire process, upload any documentation and sign the registration form on this form.

You can also save this form and return to finish at a later date - you must provide an email address to have the form link sent if you close the form.

Who is Completing this form?*

First NameLast Name
Contact Email address
Contact Email address of person completing this form
Contact Phone Number*
Please enter a valid phone number we can call if we have questions.

PLEASE SELECT the year, school, and grade you wish to enroll your student in.

* Please note that HIGH SCHOOL REGISTRATION IS NOW ACTIVE - if you are enrolling in Grade 10, 11 or 12 choose "GRADE 10-12" for the program. *
Which School Year ?*
Which program?*
What GRADE LEVEL will the student be enrolling in?*

STUDENT NAME
Enrollment Start Date

MonthDayYear
First Day this student will attend school
LEGAL Name*

First NameMiddle NameLast Name
Please upload documentation -
BIRTH CERTIFICATE is the usual document accepted.
Birth certificate or other government LEGAL NAME DOCUMENTATION

Please upload a document that would show the LEGAL NAME
Cancelof
Preferred First Name*
This is the name the student wished to be called in class

PHYSICAL HOUSE ADDRESS
This is where {preferredFirst} Lives
Address Location*

ON RESERVEOFF RESERVE
House/Unit # and Street Address (EG 34 ManyBerry Lane)

Street Address Line 2

CityProvince

Postal / Zip Code
Home Phone*
This is the FIRST # we use when trying to reach a parent or guardian at the student’s home.
Home Phone Type*

LAND LINEMOBILE (Can Text)MOBILE (No Text)

Siblings

	FIRST NAME	LAST NAME	SCHOOL ENROLLED
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Sibling 5
Sibling 6

MAILING ADDRESS where {preferredFirst} lives.
Street Address or Box Number

Street Address Line 2

CityPROVINCE

Postal Code

Please list up to five (5) ADULT contacts for {preferredFirst}

This would include mother/father/guardians or other primary caregivers who live with {preferredFirst}.

Please create/verify a CONTACT record for {birthMother} / {birthFather} if they are direct caregivers for {preferredFirst}.

Please also list any current emergency contacts or adults who are allowed to pick up or drop off {preferredFirst}

Being able to allow you to add multiple phone numbers, email addresses, etc is relatively new for our system. We appreciate your help keep our contact information up to date.

On the next screen, you will be prompted to add these contacts.

CONTACT Summary Review (Click BACK to make changes)

CONTACT 1 - {name} / {relationshipTo}

{pleaseClick}

CONTACT 2 - {name96} / {relationshipTo97}

{pleaseClick98}

CONTACT 3 - {name141} / {relationshipTo142}

{pleaseClick143}

CONTACT 4 - {name151} / {relationshipTo152}

{pleaseClick153}

CONTACT 5 - {name161} / {relationshipTo162}

{pleaseClick163}

Family Circumstances
Are there any special family circumstances that we should know about?
Usually the birthparents listed as {birthMother217} or {birthFather} are legal guardians.

PLEASE INDICATE BELOW IF THERE IS A DIFFERENT GUARDIANSHIP ARRANGEMENT.
Are there special Guardian arrangements we need to be aware of?*

YESNO
GUARDIANSHIP

Guardians of the student must be identified to ensure each party’s rights are respected. If an order does exist affecting guardianship rights or custody or access rights, a copy of the order will be required to be placed in the student record. The court seal must be evident on the order. In rare instances, a child may be designated as “protected” if a court issues a restraining order under the Child Welfare Act, the Divorce Act, the Young Offenders Act, or similar legislation.

Where a person claims to be a parent or guardian or claims the existence of any limitation on the authority of a parent or guardian, the onus is on the person to provide proof of the claim. Please ensure that the Authority has copies of all current orders or agreements addressing guardianship rights, responsibilities, and entitlements or otherwise affecting the custody of or access to your child.
Guardianship / Custody Info
If the listed parents (Mother and Father) are not current legal guardians - or there is particular custody arrangments.
Does a legal document exist to detail guardianship?

YESNO
Guardianship Type / Document

KinshipTemporary Guardianship OrderTemporary Guardianship OrderAccess or Custody OrderOther
Court Documents for Guardian / Custody Information

Cancelof

MEDICAL and OTHER ALERT INFORMATION FOR {preferredFirst}
Please select any of the following medical conditions that may apply to this student

DiabetesEpilepsyAlergies (list in the box below)HemophilliaHeart ConditionOther
Medial Alert Info*
Please list the details of the items checked above (what algeries etc)
My Child regularly takes medication*

YESNO
Please provide medication details
List any schedules or requirements for medication to be dispensed at school - the School Nurse will contact you about what we are able to provide.
Alberta Health Care Number*
Other Info
(Not covered above ... but critical information needed for school care or registration)

We utilize the services of "Creative Communicators" for Speach Language Therapy, Occupational Therapy, and Physiotherapy - Please review and complete the following consent. We realize that not all students require these services, but when an assessment is required CONSENT is required by our service provider - giving your consent now helps speed up the process.

---

Creating Communicators and affiliates will provide screening, assessment and/or treatment for speech-language, occupational therapy and/or Physiotherapy intervention in a group or one on one setting. Participation in an assessment, consultation and/or as deemed necessary. A registered speech and language pathologist/occupational therapist/physiotherapist will provide an assessment, as well as consultation and supervision. This consent is valid from the date signed until either the services are no longer required or the parent/guardian withdraws consent. The parent/guardian may withdraw consent at any time.

If you have any questions regarding our assessment or treatment process please call Mindy Olson-Pizzey, Director at 780 805-6645. mindy@creatingcommunicators.net

For {legalName} I authorize:
- The release of all pertinent information to Creating Communicators and affiliates (i.e., medical information, speech-language information, occupational therapy information, psychological testing, physiotherapy, or information from other professionals) to assist in the implementation of an appropriate evaluation and treatment program.
- The release of information obtained during speech and language assessment, treatment and intervention to the referral source.
- The use of digital recording (for the use of Creating Communicators’ only) during testing and/or intervention, as it may be necessary for progress and comparison purposes to determine the results of the treatment program.
PLEASE ACKNOWLEDGE YOUR CONSENT FOR EACH OF THESE SERVICES*

SPEECH LANGUAGEOCCUPATIONAL THERAPYPHYSIOTHERAPYNO CONSENT (I realize this may delay services as consent IS required should these services be requested)
Signature of
Creative Communicators Service Provider Consent

Clear

From time to time your child may be seen by one of our Physical Therapy service providers - please complete this consent to avoid delay in delivery of services if required. PLEASE REVIEW THIS CAREFULLY - if you have questions you can direct them to our office.

Consent for Physical Therapy Services and Consultation

I {whoIs} as the legal guardian/parent of {legalName} grant authorization for {legalName} (a minor) to be seen for Physical Therapy Services.

I understand that physical therapy services include assessment, intervention, consultation, and documentation of my child’s skills and progress and will include things such as running, jumping, and kicking a ball.

Assessment may include observation of my child, formal and informal testing, follow-up visits, and ongoing intervention. I understand I will be offered the opportunity to discuss the results of my child’s progress with the Physical Therapist.

I understand that information such as treatment plans, program goals, assessment results, and summary reports may be shared with other healthcare professionals who are part of my child’s team as well as other educational professionals at the school but will not be released to any other person or organization without my written permission except where required by law or professional obligation.

My signature below indicate(s) that I understand and agree to the information presented above and that I freely consent to have my child participate in the above-mentioned physical therapy services. I understand that consent is voluntary and can be withdrawn by me, in writing, at any time.
I grant authorization*

YESNO
You provided us these contacts - which one should our Physical Therapist contact with respect to concerns with {legalName}

CONTACT 1 - {name} / {relationshipTo}

CONTACT 2 - {name96} / {relationshipTo97}

CONTACT 3 - {name141} / {relationshipTo142}

CONTACT 4 - {name151} / {relationshipTo152}

CONTACT 5 - {name161} / {relationshipTo162}
BEST CONTACT IS

Contact 1Contact 2Contact 3Contact 4Contact 5
Please share any concerns or observations you would like us to know:
Signature of
Signature

Clear

USING AND DISCLOSING PERSONAL INFORMATION

Bigstone Cree Nation Education Authority recognizes that all procedures for the collection and storing of information by Authority staff in the course of affairs and procedures regulating the release of information to other parties must follow provisions of the Freedom of Information and Protection of Privacy Act (FOIP).

By signing this section you indicate you understand the above.
Signature of
FOIP acknowledgement*

Clear
DIGITAL CITIZENSHIP AND TECHNOLOGY USE

As a condition of using Bigstone Cree Nation Education Authority network resources, I understand that access to authority information resources, including access to internet and authorized cloud-based resources, is a privilege and agree to abide by the regulations identified in the Bigstone Cree Nation Education Authority Procedures.
Signature of
Signature of understanding of Technology use statement *

Clear
Consent to Post Personal Information

BCNEA is requesting permission to use your child’s personal information (image, grade and/or name, etc.) outside of the school community.

I understand that once provided, consent, in whole or in part (e.g. last name or photo, etc.), can be revoked at any time by written notification provided to my child’s school, acknowledging that although photos/videos will be removed from websites and social media accounts, it may not be possible to remove all traces of personal information from the Internet.
YES, I consent to my child’s personal information, which may include photos, videos or student work being shared in the following ways (select all that apply):

on the Internet, including pictures, videos, podcasts or presentations, publicly in brochures, booklets, educational websites, at external educational presentations (e.g.,Teachers’ Convention) or on social media (e.g., Facebook, Instagram, YouTube and Twitter)in memory books, CDs and video recordings of activities such as year-end, concerts, presentations, field trips that are shared with parents, guardians and studentsto use, publish, display, written material, or creative work created or authored by my child through school activities. I understand that artwork, written material, or creative work may be used by BCNEA in authority or school displays, publications, websites, social media, other electronic media and advertising or promotional materials. I understand that BCNEA may make minor edits as deemed appropriate
Signature of
OR ... SELECT ONLY OF YOU DO not consent to my child’s personal information being used or disclosed for any of the stated purposes.

NO
Consent of Personal Information Post Signature*

Clear
SCHOOL ACTIVITIES

Please indicate by selecting the following boxes the various school activities you grant permission for {preferredFirst} to participate in for the 2023.24 school year.
School Activities Permission (Select to indicate YES - leave blank for NO)

Permission to be transported to/from and in participate in activities at KapaskwatinakPermission to Participate in SmudgingPermission to participate in Christian PrayerPermission to be transported to/from and participate in community activties within the 50KM radius of the school
Signature of
School Activity Permissions choices*

Clear
DECLARATION - SIGNATURE REQUIRED

By signing below, I ({whoIs} hereby declare I have read and understood the information contained on this form and the information I have provided is correct. I accept responsibility to advise the school if there is any change to this information or Kingston’s registration status for the upcoming school year.

I am the legal guardian or the independent student referred to in this registration form. I have read and understand the information regarding guardianship and I have identified all guardians for this student. I hereby certify the foregoing information to be true, correct, and complete.
Signature of
FORM COMPLETED ON*

MonthDayYear
Completed Date
Signature*

Clear
Should be Empty:

BIGSTONE CREE NATION EDUCATION AUTHORITY

Collection and Use of Personal Information Disclaimer

STUDENT NAME

PHYSICAL HOUSE ADDRESS
This is where {preferredFirst} Lives

MAILING ADDRESS where {preferredFirst} lives.

{legalName} - PARENT/CAREGIVER OR GUARDIAN #1

{legalName}- PARENT/CAREGIVER OR GUARDIAN #2

{legalName}- ADDITIONAL ADULT CONTACT #1

{legalName}- Relevant Adult CONTACT #2

{legalName}- ADDITIONAL CONTACT #3

Usually the birthparents listed as {birthMother217} or {birthFather} are legal guardians.

PLEASE INDICATE BELOW IF THERE IS A DIFFERENT GUARDIANSHIP ARRANGEMENT.

GUARDIANSHIP

MEDICAL and OTHER ALERT INFORMATION FOR {preferredFirst}

Consent for Physical Therapy Services and Consultation

USING AND DISCLOSING PERSONAL INFORMATION

DIGITAL CITIZENSHIP AND TECHNOLOGY USE

Consent to Post Personal Information

SCHOOL ACTIVITIES

DECLARATION - SIGNATURE REQUIRED

BIGSTONE CREE NATION EDUCATION AUTHORITY

Collection and Use of Personal Information Disclaimer

STUDENT NAME

PHYSICAL HOUSE ADDRESS This is where {preferredFirst} Lives

MAILING ADDRESS where {preferredFirst} lives.

{legalName} - PARENT/CAREGIVER OR GUARDIAN #1

{legalName}- PARENT/CAREGIVER OR GUARDIAN #2

{legalName}- ADDITIONAL ADULT CONTACT #1

{legalName}- Relevant Adult CONTACT #2

{legalName}- ADDITIONAL CONTACT #3

Usually the birthparents listed as {birthMother217} or {birthFather} are legal guardians.

PLEASE INDICATE BELOW IF THERE IS A DIFFERENT GUARDIANSHIP ARRANGEMENT.

GUARDIANSHIP

MEDICAL and OTHER ALERT INFORMATION FOR {preferredFirst}

Consent for Physical Therapy Services and Consultation

USING AND DISCLOSING PERSONAL INFORMATION

DIGITAL CITIZENSHIP AND TECHNOLOGY USE

Consent to Post Personal Information

SCHOOL ACTIVITIES

DECLARATION - SIGNATURE REQUIRED

PHYSICAL HOUSE ADDRESS
This is where {preferredFirst} Lives