Registration Form 2019-2020
Child's Information
Student Name
Date of Birth
Gender/Sex
Male
Female
Grade
Junior Kindergarten
Senior Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Previous School
Parent/Guardian Information
Father's Name
Mother's Name
Father's Address
Canada
Mother's Address
Canada
Contact Information
Home Phone
Cell Phone
Alternate Phone
Father's Email
Mother's Email
Emergency Contact Information
Name
Address
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestina
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts & Nevis
St Lucia
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Other
Home Phone
Cell Phone
Alternate Phone
Email
School Bus
Transportation service may be available from Brampton and Mississauga (subject to available spot in the bus), using standard yellow school busses. are you interested in school bus for your child ?
Yes
No
School Directory
I authorize Al-Ameen Elementary School to include the names, email addresses and other contact information for our immediate family in the school directory.
Yes
No
Photographic Authorization
Photographs of my child may be used in the advertising/promotion of the Al-Ameen Elementary School in any medium and without any royalty.
Yes
No
Medical and Allergy Information and Restrictions
All medications administered at school need a complete Medication form. Please see the administration for further information. Please list any medical conditions, chronic or relevant developmental information and if any special accommodations are needed for your child. For allergies, parents/guardians are required to give written instruction on what the school needs to do in the case of allergic reaction, under “steps to take”
Known allergies and Steps to take should a reaction occur
Special diet
Physician Information
Physician's Full Name, Address and Phone Number
Declaration and Authorization
I understand that minor injuries or accidents will be treated on the school premises and that I will be notified of any such treatment. I also understand that certain medical information may need to be shared with the school staff if deemed necessary by the administration and I hereby give my consent for the disclosure of information otherwise protected by HIPAA, including protected health information, with the school and its agents. The information and health history in this form is correct to the best of my knowledge, and the person herein described has permission to engage in all activities, except as noted in this form.
I Agree
Yes
No
Compliance Policy In compliance with provincial regulations, I will pick-up my child as soon as possible in the event that Al-Ameen Elementary School calls to inform me that my child is ill. I agree to inform Al-Ameen Elementary School immediately of communicable illnesses any of my family members contract even if they do not attend Al-Ameen Elementary School. I Agree
Yes
No
Terms and Conditions
Al-Ameen Elementary School admits students without regard of any race, color, national origin, religion or ethnic background. Any fees paid to the school, including tuition or activity fees, are non refundable. No refunds will be due or issued as a result of a day missed due to illness, holidays or vacations or if the school is closed as a result of weather or other events beyond our control. Each student (and their family) agrees to abide by all of the rules and regulations published by the school from time to time on its website or otherwise distributed. The rights, obligations and responsibilities here under shall transfer to any successor in interest or acquirer of the assets or interests of the school. All student records are considered confidential. They may be available to parents and legal guardians up on request by them to the school. Student records will only be released to other schools or agencies upon the signed request/legal guardian and only after all accounts due to the school are paid in full. I understand that the school and its agents are required to report suspected child abuse or neglect.
I Agree
Yes
No
Name
Relationship to Child
Father
Mother
Legal Guardian
Digital signature
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Date
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