Piapot First nation
Student's Treaty Number
Which Band is the student registered.
Saskatchewan Health Card
How many siblings does student have?

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Please ensure the numbers are active and working
Mother/Female caregivers number:
Mother/Female caregivers number:
Mother/Female caregivers number:

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Please ensure the numbers are active and working
Father/Male caregivers name:
Father/Male caregivers name:
Father/Male caregivers name:

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Please ensure the numbers are active and working
Emergency Contact 1st
Emergency Contact 1st
Emergency Contact 1st

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Please ensure the numbers are active and working
Emergency Contact 2nd
Emergency Contact 2nd
Emergency Contact 2nd

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Student Medical Information:

Waiver/Release

  • In case of emergency I give permission to Payepot School staff to release any medical information to our local health center(s) for proper care and transportation of your child to the nearest medical facility.
  • I give permission to Payepot School to administer any Assessment/Testing for the purpose of Resource Support, measuring school goals and anything else deemed necessary for the academic growth of your child. (WIAT, TTFM, BASC)
  • I give my child permission to attend any field trips or sporting events throughout the school year.  A note/reminder will be sent out prior to the event.
  • MEDIA RELEASE – I hereby agree and give my permission for Payepot School or partners to record, film, photograph, audiotape or videotape my child’s name, image, student work and performance (hereinafter collectively referred to as “Works”) to display, publish or distribute these Works for the purpose of publishing, posting on the Piapot First Nation/Payepot School website and or social media sites, posting in schools, and/or for broadcasting on television or radio as determined by Payepot School.  I hereby waive any right to approve the use of the Works now or in the future, whether the use is known to me or unknown.  I waive any right to any royalties related to the use of these Works.  I understand that the Works may appear in electronic form on the internet or in other publications outside of the Payepot School’s control.  I agree that I will not hold Payepot School responsible for any harm that may arise from such reproduction.
  • I give permission for my child to see or be recommended to see appropriate professionals/staff and outside agencies in regards to my child’s emotional well being as the staff at the school deem necessary and for the best interest of my child.
I understand and gives consent to all of the above bulleted information/requests.