Forms

Student/Parent and Guardian Registration Form: Student Registration Information

Registration Date(Required)

Student's Legal Name(Required)

First Middle Last

Registering for Grade(Required)

Student's Preferred Name

First Last

Student's Mailing Address(Required)

Street Address Address Line 2 City Postal Code

Student's Home Phone Number(Required)

Student's Cell Phone Number

Student's Birthdate(Required)

Student's Gender

Student's Age(Required)

Please enter a number from 1 to 20.

Alberta Student Number(Required)

Student's Previous School

Previous School's City/Province

City Province

Citizenship or Immigration Status:

Canadian or Child of a Canadian Citizen(Required)

Yes

No

Copy of Birth Certificate on File(Required)

Yes

No (see * below)

*** All students require a copy of their birth certificate on file. A copy of the birth certificate must be submitted to the school, if no previously done. ***

Individual who is lawfully admitted to Canada for permanent or temporary residence or child of that individual (excludes tourists and visitors)

Refugee Status

Other, explain

Any Applicable EXPIRY DATE

Do you reside on an Indian Reserve?

Yes

No

If you reside on an Indian Reserve, please indicate the reserve, band and status number:

Reserve

Band

Status Number

Parent/Guardian Information

Please identify each legal guardian for the child being enrolled. The legal guardian is the parent or person legally appointed as guardian; as defined Section 2 of the School Act and within the Family Law Act, Corrections Act, Corrections and Conditional Release Act, Young Offenders Act, or Child, Youth and Family Enhancement Act.

Parent/Guardian(Required)

Full Name(Required)

First Middle Last

Same Address As Student(Required)

Yes

No

Address

Street Address Address Line 2 City Province Postal Code

Phone Number(Required)

Alternate Phone Number

Work Phone Number

Other Phone Number

Email

Parent/Guardian

Full Name

First Middle Last

Same Address As Student

Yes

No

Address

Street Address Address Line 2 City Province Postal Code

Phone Number

Alternate Phone Number

Work Phone Number

Other Phone Number

Email

Custody Information Appendix A

Parenting Order/Custody & Access Form

Are there any Court Orders affecting access to the student?(Required)

Yes

No

Please fill out Appendix A on this form and provide a copy of the order for the student’s file

Custody/Access Concerns?

Full Name

First Middle Last

Phone Number

Alternate Phone

Full Name

First Middle Last

Phone Number

Alternate Phone

Has a copy of the court order already been provided?(Required)

Yes

No

Copy of Court Order

Accepted file types: jpeg, gif, png, pdf, Max. file size: 10 MB.

2. Emergency Contact and Medical Information:

Emergency Contact Information: Other then Parents/Guardian

Full Name(Required)

First Middle Last

Relationship To Student

Phone Number(Required)

Alternate Phone Number

Full Name

First Middle Last

Relationship To Student

Phone Number

Alternate Phone Number

Appendix B: Student Allergy Form

Does the student have allergies and/or a medical condition that is potentially fatal or debilitating?

Yes

No

Allergy Note

Emergency/Medical Note:

Note

Medical Disabilities

Physical Disabilities

Serious Illness

Has your child had any previous special needs testing or assistance?

Yes

No

Program Name:

Contact

3. Transportation

Physical Address where the student resides(Required)

Street Address Address Line 2 City Province Postal Code

Does the student live in a rural area?(Required)

Yes

No

Legal Land Description(Required)

Municipal Address(Required)

4. Declarations:

Independent Student Status:

The School Act defines an independent student as someone who is (i) 18 years of age or older, or (ii) 16 years of age or older, and (a) who is living independently, or (b) who is a party to an agreement under 57.2 of the Child, Youth and Family Enhancement Act.

Are you claiming status as an "Independent Student" under the definition of the School Act?

Yes

No

Aboriginal Learner Data Collection Initiative:

Do you which to declare that you are an Aboriginal person?

Yes

No

Please specify:

For further information or if you have questions regarding the collection activity, please contact the office of the Director, Aboriginal Policy, Strategic Services Division, Alberta Education

10155–102 Street, Edmonton T5J 4L5, (780) 427-8501.

Section 23 Eligibility (Francophone Education):

According to Section 10 of the School Act and Section 23 of the Canadian Charter of Rights and Freedoms, the following applies to Canadian citizens’ rights to have all their children receive primary and secondary instruction in French: Citizens of Canada • whose first language learned and still understood is French or • who have received their primary school instruction in French or • who have one or more children in the family having received or are receiving primary or secondary school instruction in French, in Canada.

According to these criteria, do you claim to be eligible to have this child education in French?

Yes

No

Do you wish to exercise your right to have your child education in French?(Required)

Yes

No

In Alberta, parents can only exercise this right by enrolling their child in a French first language (Francophone) program offered by a Francophone Regional Authority. To exercise your Section 23 rights, you must enrol your child with one of the five Francophone Regional Authorities listed below: • The Northwest Francophone Education Region No. 1 – St. Isidore (780) 624-8855 • The Greater North Central Francophone Education Region No. 2 – Edmonton (780) 468-6440 • The East Central Francophone Education Region No. 3 – St. Paul (780) 645-3888 • The Greater Southern Separate Catholic Francophone Education Region No. 4 – Calgary (403) 685-9881 • The Greater Southern Public Francophone Education Region No. 4 – Calgary (403) 686-6998.

English as a Second Language (ESL) Eligibility:

A child or student may be eligible for English as a Second Language (ESL) supports when the primary language spoken at home is a language other than English and a current school year assessment demonstrates insufficient fluency in English to achieve grade level expectations in English Language Arts and other subject areas.

According to these criteria, do you believe your child qualifies for ESL?

Yes

No

Please specify the primary language spoken at home(Required)

ANDREW RURAL ACADEMY’S FOIP NOTIFICATION

Freedom of Information and Protection of Privacy Act (FOIP Act)

Collection of Personal Information Notice under s. 34 of the FOIP Act

The FOIP Act, which came into effect for school boards on September 1, 1998, sets controls and standards on how public bodies, such as school boards, collect, use and disclose personal information that is in their custody or under their control. The FOIP Act requires that school boards collect personal information directly from individuals the information is about, that these individuals be provided with the legal authority for the collection, be explained the purpose of the collection and how the information will be used, and be provided a contact person should they have any questions relating to this activity.

• The information collected on this form as part of the school registration process is personal information as referred to in the FOIP Act. This personal information is collected pursuant to the provisions of the School Act and its regulations (e.g. for the establishment of a student record, determination of residency) and pursuant to section 33(c) of the FOIP Act as the collection is related directly to and is necessary to a school board’s obligation to provide students with an education program that meets their needs and to provide a safe and secure school environment (e.g. program placement, determination of eligibility and/or suitability for provincial or federal funding, contact and health related information in the event of problems or emergencies). Personal information may also be provided to the Minister of Education for the purpose of carrying out programs, activities, or policies under his administration (e.g. research, statistical analysis).

Once the information is collected and compiled, Andrew Rural Academy believes the uses listed below are part of a vital, healthy and functioning school and participation of all students is important and encouraged. Here are examples of activities where the information may be used:

• the taking of individual, class, team or club photos or information including awards, school events or student marks for school purposes including school publications such as newsletters, yearbooks, school/charter websites and similar publications the use of student information, including photos, for other identification purposes

• the use of students’ names in honour rolls, work ethic (listings), graduation ceremonies, program enrollment, scholarship or other awards within the school or school charters and at school sponsored events such as annual awards night. This information may be included in school newsletters, yearbooks, school/charter websites and similar publications

• the use of students’ names and academic information necessary for determining eligibility or suitability for provincial, federal or other types of awards or scholarships in the event the board applies on a student’s behalf

• the use of students’ names, related contact information and telephone numbers for absenteeism verification

• the taking of photos and/or videos of classroom activities, and their use by the media or other organizations where students are not interviewed or identified by name or face. Where individual students are identified or interviewed and the material will be used outside the school a separate and specific consent will be required. You will be contacted prior to this event taking place. Please note that photos and/or videos of school activities that are open to the general public may be taken and used for purposes within and outside of the school.

• the taking of photos/videos of classroom or other school activities by the school board where the material will be used within the school. Where individual students are identified or interviewed and the material will be used outside the school, a separate and specific consent will be required. You will be contacted prior to this event taking place.

• the use of students’ names on artwork or other creative work or material of students displayed at school or school board sites or at a school board sponsored display in the community, provided appropriate copyright legislation is followed. If you have any questions or concerns regarding the collection and the intended purposes, please contact the Secretary Treasurer at Andrew Rural Academy Charter School, (780) 365-XXXX.

If you wish to request that your child’s personal information be withheld for any reason, please contact the School Principal directly.

Declaration(Required)

Yes

No

I have read the Andrew Rural Academy Charter Schools’ FOIP Notification and understand that my child’s personal information will be used to provide an education program that meets their needs and provide a safe and secure school environment.

Student's Name

First Middle Last

Parent/Guardian Name

First Middle Last

Date

Parenting Order/Custody & Access Form

There are occasions where child guardianship concerns involve the school. If your child is in a situation relating to any of the orders below, please complete the appropriate section(s) so the school has the necessary information to follow a proper course of action. The school must be supplied with a copy of the order and the court seal must be evident on the order.

Custody and Access Order(Required)

Yes

No

Both the custodial and the non-custodial parents have access to the child. If the non-custodial parent wants to take the child from the school, the school can attempt to contact the custodial parent and advise of the situation. The school cannot try to prevent the non-custodial parent from taking their child.

Name of Child(Required)

First Middle Last

Name of Custodial Parent(Required)

First Last

Name of Non-Custodial Parent(Required)

First Last

Phone Number(Required)

Contact phone number if an incident occurs or concerns arise at the school

Custody/Access Concerns

Legal Restraining Order(Required)

Yes

No

One parent has custody and the other parent has a restraining order from a court prohibiting contact with the child. If the non-custodial parent takes the child from school, the school must call the RCMP and advise them of the situation. From that point on, it is a police matter. The school will attempt to contact the custodial parent and inform them of the situation.

You must be aware that the school and its personnel will take responsible actions should an incident occur, but we may not be able to make phone contact with the custodial parent, and we are not legally allowed to prevent any parent from accessing their child. If you would like further clarification on this matter, please contact the School Principal.

Parenting Order(Required)

Yes

No

The courts may make a Parenting Order when a child has more than one guardian (usually parents) who live apart and are unable to agree on how to distribute powers, responsibilities and entitlements of guardianship.

What is the allocation of decision making powers

What is the dispute resolution process

Allocation of parenting time

Other

Contact Order(Required)

Yes

No

A Contact Order involves contact between the child and persons other than the guardian—such as grandparents and other people who might be important to the child. An application for in-person visitation or other contact, such as by telephone or e-mail, can be made if a guardian has denied contact with a child.

What are the conditions/limitations of the contact?(Required)

I have read and understand the above information. Also, I believe to the best of my knowledge that the information I have provided is accurate.

Parent's Name(Required)

First Middle Last

Date(Required)

Student Allergy Record Form – Appendix B

Date

This form is to be completed for students identified as having severe allergies that are potentially fatal or debilitating.

This form must be signed by the student’s medical practitioner and parent (or guardian).

Please provide the following information: 1. Identify the substance(s) to which the student is known to be allergic to. 2. List the symptoms of the allergic reaction(s). 3. List detailed emergency procedures to be followed in the event of an allergic reaction. 4. If medication is to be administered as part of the emergency procedure, the following information must be provided: • name of medication • required dosage • method of administration • possible side effects • special storage instructions • the time framework within which the medication must be administered

Student's Name(Required)

First Middle Last

Allergy Record(Required)

Allergy To

Symptoms

Emergency Procedures

Medication Details

Parent or Guardian Name(Required)

First Last

Medical Practitioner's Name(Required)

First Last

Andrew Rural Academy Charter School

Student Acceptable Use of Technology Agreement – Appendix C

Background

Andrew Rural Academy Charter School supports a learning and working environment in which students can communicate, collaborate, and access and create information. Andrew Rural Academy Charter School is committed to maintaining an accessible and safe digital environment. To that end, all ARA students are expected to manage information technology resources in a manner that takes responsibility for and is respectful of the safety and well-being of all users. Use of Andrew Rural Academy Charter School’s information technology resources must comply with all applicable laws, Alberta Education guidelines, and Academy policies and procedures.

Procedures

1. Academy technology resources are to be used primarily for activities related to the mission and vision of the Academy. Academy technology is intended for educational purposes. Personal use of technology resources, including network bandwidth and electronic storage space, must not interfere with, or conflict with, use for educational purposes. 2. Academy technology resources may not be used for purposes that are illegal, unethical, or immoral. Use of Academy technology resources for disruptive, fraudulent, harassing, threatening, obscene (including but not limited to racist, profane and pornographic), or malicious purposes is strictly prohibited. 3. Activities involving Academy technology resources will, as much as possible, protect the privacy of information and personal safety of all users. Specifically, permission must be obtained by all individuals before sharing information in any format (eg. visual, audio, text-based), about any Andrew Rural Academy student or staff member. 4. Individuals using Academy technology resources shall not compromise the security of the Academy network and data. The Academy holds users responsible to protect their passwords and keep them private to ensure the security of all Academy technology. Students will not use @edu.andrewruaralacademy.org to access any technology resource not authorized by the Academy, or for personal use. 5. Users of Academy technology resources do not have a right to an expectation of privacy. For the purpose of ensuring responsible use, the Academy reserves the right to monitor any activity occurring with its technology resources. Use of the Academy’s technology resources implies the user’s consent to monitoring for security purposes. 6. Andrew Rural Academy Charter School prioritizes the importance of well-being and supports a balance between personal and professional life. Caregivers and students are encouraged to communicate with employees during the workday and to understand they may not receive a response after hours. 7. The Academy shall not be responsible for the loss, theft or damage of personally owned technology. 8. All users are expected to handle Academy equipment with care and respect and may be held responsible for the cost of replacement or repairs if found responsible for loss or damage. 9. Any student violating these procedures, or any applicable provincial, federal, or international laws, or posted classroom, school, or Academy rules, is subject to loss of technology privileges, and any other Academy disciplinary options.

Student's Name(Required)

First Middle Last

Student's Grade(Required)

Parent/Guardian's Name

First Last

Date

Agreement(Required)

I have read and understand the above Andrew Rural Academy procedures for the acceptable use of technology.

As a parent or legal guardian, I have reviewed the above information and provide consent for my child to use technology as required by Andrew Rural Academy Charter School and to allow my child to access the Andrew Rural Academy network services for the duration of their time as an enrolled student in the Andrew Rural Academy Charter School. I understand that my child will be accessing digital content and services online as outlined in the Andrew Rural Academy Technology Code of Conduct. I understand that if the school has concerns with my child’s technology use, digital access or online behavior that they will contact me to determine a solution.

Questions can be directed to your child’s teacher or school principal.

Andrew Rural Academy

info@andrewruralacademy.ca

4922-50th Ave

Andrew, AB T0B 0C0

Canada’s Anti-Spam Law came into effect on July 1, 2014. The Anti-Spam Law states that without your consent, we will be unable to send you communications electronically.

Andrew Rural Academy Charter School wants to continue to keep you up-to-date and informed about the latest school and school information, events and announcements through electronic communications such as emails and newsletters from Andrew Rural Academy Foundation and its school, trustees, school councils, service providers, and other organizations associated with Andrew Rural Academy Charter School. Occasionally, these communications may include information about offers, advertisements or promotions related to school activities such as events, yearbooks, field trip opportunities, student photos, or similar school-related activities.

To receive the above mentioned electronic communications, please complete the form below to indicate your consent and return to your child’s school. Please note that if you do not return the completed form we will be unable to continue to send you electronic communications.

If you have any questions, or wish to withdraw your consent at any time, please contact the secretary of your child’s school and have your name removed from the consent list.

Name of Student(Required)

First Middle Last

Student's Grade(Required)

Parent/Guardian's Name(Required)

First Last

Date

CAPTCHA

Andrew Rural Academy Student Registration Form