ONLINE REGISTRATION FORM:

What program are you registering your child for? *

If so, do you have a home laptop or iPad? *

âhâ (yes)
namôýa (no)

Do you have access to internet at home? *

âhâ (yes)
namôýa (no)

Legal Name (first/middle/last): *

First

Middle

Last

Date of Birth: *

Grade: *

Mailing Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

House # *

Piapot First nation

Treaty Number: *

Student's Treaty Number

Band *

Which Band is the student registered.

Hospitalization Number: *

Saskatchewan Health Card

Last School Attended: *

Saskatchewan Learning Number (SDS):

Bus Driver:

Are youable to drive your child to school? *

âhâ (yes)
namôýa (no)

Siblings: *

How many siblings does student have?

Name of sibling *

First

Last

Sibling 1

Grade:

If Sibling 1 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 2

Grade:

If Sibling 2 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 3

Grade:

If Sibling 3 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 4

Grade:

If Sibling 4 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 5

Grade:

If Sibling 5 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 6

Grade:

If Sibling 6 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 7

Grade:

If Sibling 7 is also registered at Payepot School list grade.

Name of sibling: *

First

Last

Sibling 8

Grade:

If Sibling 8 is also registered at Payepot School list grade.

____________________________________

Parent/Guardian Information:(Mother/Female caregivers name:) *

First

Last

Please ensure the numbers are active and working

Email *

Home Number *

Mother/Female caregivers number:

Cell Number *

Mother/Female caregivers number:

Work Number

Mother/Female caregivers number:

____________________________________

Parent/Guardian Information:(Father/Male caregivers name:) *

First

Last

Please ensure the numbers are active and working

Email *

Home Number *

Father/Male caregivers name:

Cell Number *

Father/Male caregivers name:

Work Number

Father/Male caregivers name:

____________________________________

Emergency Contact Information: *

First

Last

Please ensure the numbers are active and working

Home Number *

Emergency Contact 1st

Cell Number *

Emergency Contact 1st

Work Number

Emergency Contact 1st

____________________________________

Emergency Contact Information: 2nd *

First

Last

Please ensure the numbers are active and working

Home Number *

Emergency Contact 2nd

Cell Number *

Emergency Contact 2nd

Work Number

Emergency Contact 2nd

____________________________________

Student Medical Information:

List all known Medical Information

Are immunizations up to date: *

âhâ (yes)
namôýa (no)

Food Allergies:

Drug Allergies:

Treatment(s):

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.

Waiver/Release *

I have read Payepot School Waiver/Release for 2020/2021 School year and give my consent.

Parent/Guardian Signature: *

I understand and gives consent to all of the above bulleted information/requests.

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

Student Medical Information:

Waiver/Release

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