Use this form to begin the registration process for your child. Student's Last Name Student's First Name Date of Birth (Please use 0000-00-00 format, yr-mo-da, all others will NOT work) Health Card Number Street Address Postal Code Home Phone Number Family Email Address City Current Grade Will you be requiring Before and After Care? YesNo If Before and After is required what days and times (**also if there is a different person picking up a password and ID are needed**). Mother's Full Name Mother's City Mother's Street Address Mother's Postal Code Mother's Home Phone Number Mother's Work Phone Number Mother's Cellular Number Mother's Other Number Father's Full Name Father's Street Address (if different from above) Father's City (if different from above) Father's Postal Code (if different from above) Father's Home Phone Number (if different from above) Father's Work Phone Number Father's Cellular Number Father's Other Number Child's Doctor's Name Child's Doctor's Phone Medical Information (allergies and other relevant information) Emergency Contact #1 1st Emergency Contact Number Emergency Contact #2 2nd Emergency Contact Number Hillcrest Potential Starting Date 1st Previous School School Address School City Start Date End Date 2nd Previous School (if any) School Address School City Start Date End Date 3rd Previous School (if any) School Address School City Start Date End Date Permission Any expenses incurred for any kind of medical attention, will be borne by the child’s family. The school will not be responsible for anything that may happen as a result of false information given at the time of enrollment. I hereby grant permission for my child to use all of the play equipment and participate in all the activities of the school. I hereby grant permission for my child to leave the school premises under the supervision of a staff member for neighbourhood walks or for field trips in an authorized vehicle. I hereby grant permission for my child to be included in all games and activities with all the other children and will not hold the school responsible for any injuries that may occur from these activities. I hereby grant permission for the person in charge that day to take whatever steps may be necessary to obtain emergency medical care if warranted. If we cannot contact you or your child’s physician we will do any or all of the following: 1) Call another physician or paramedics. 2) Call an ambulance. 3) Have the child taken to an emergency hospital in the company of a staff member. PLEASE READ CAREFULLY **With the enrolling of my child at Hillcrest Private School, I will supply the school with 10 post-dated cheques dated the first of each month from September to June at the start of the school year. There is a 2% interest charge on all outstanding account balances and a $35 service charge for any returned cheques. Families who have outstanding balances will be asked to leave the school and will not return until their accounts are in good standing. ***A one month “written notice” must be given for any changes in student attendance. I agree to the terms above *Form will NOT submit unless you click box to agree* SIGNED: __________________________DATE:_______________________ Please enter code above (this is just to prove you are human) ****If this form is not "submitting" then you may have not filled in all the required information above.**** Filling out this form DOES NOT immediately register a student for Hillcrest Private School. You must have been accepted by administration and have had an interview with the Principal to complete the process.