Chinook Learning Services Student Registration Form

Instructions
This form must be completed by all students who are not currently attending a Calgary Board of Education school and are
registering in Chinook Learning Services High School Upgrading or Grades 10-12 Summer School programs. Fields in this PDF form
can be input using your computer's keyboard and mouse. Print prior to signing and dating the document (File menu --> Print). Course
fees, if applicable, are due at time of registration. Waivers are not applicable.

Program Registering For: High School Upgrading Grades 10-12 Summer School

Student Information
Birth Date (MM/DD/YYYY) Gender Female Male Other/Not Disclosed

Legal Last Name AKA Last Name

Legal First Name AKA First Name

Legal Middle Name Maiden Name (if applicable)

Note: Legal name must match the name on your legal document. Student's AKA Name is a name by which the student is commonly known in
the family and community.

Address City

Province Postal Code E-mail

Cell / Work Phone Home Phone

Emergency Contacts (at least one parent/guardian or close relation is best)

1) Name Relationship Best Contact Phone

2) Name Relationship Best Contact Phone

Citizenship
Canadian Canadian Aboriginal Permanent Resident / Landed Immigrant
Child of a Canadian Citizen Refugee
Child of an Individual Under Work Permit Work Permit / Temporary Resident
International Student Birth Country Home Language

Legal Documentation
One of the following legal documents must be presented at time of registration, and a copy will be placed in the
Student File.

Adoption Certificate Canadian Birth Certificate Canadian Citizenship Card

Canadian Passport Certificate of Indian Status Permanent Resident / Landed Immigrant Card
Refugee Papers Study Permit (5-416) Work Permit / Temporary Resident (7)

Document Number Expiry Date (MM-DD-YYYY)

Chinook Learning Services Student Registration Form

Revision Date: January 15, 2019
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Aboriginal Self-Identification
If the student wishes to declare that they are Aboriginal, please select one:

First Nation (status) First Nation (non-status) Métis Inuit

For further information, please refer to: www.education.alberta.ca/system-supports/results-reporting or contact Alberta

Education at 780-427-8501.

If you have questions regarding the collection of student information by the Calgary Board of Education, please contact
the Superintendent of Learning at: [email protected]

Independent Student Status (ONLY if under 18)

Students under 18 years of age may be designated as Independent by the Principal if they meet certain criteria.

As a student, are you under 18 and wishing to declare Independent Status? Yes No

If Yes, Chinook Learning Services Principal’s signature is required for proof of Independent Status.

__________________________________________________________
Principal's Signature

Declaration of Residency
A student is considered to be a resident of the Calgary Board of Education if the student is an independent student (or
over 18 years of age) residing in the City of Calgary and not of the Roman Catholic faith, OR the parent(s)/guardian(s) with
day-to-day care of the student reside in the City of Calgary and at least one of them is not of the Roman Catholic faith.

Is the student a resident of the Calgary Board of Education (School District #19)? Yes No

School Status

Current or most recent high school attended Grade

Calgary Board of Education Calgary Catholic Calgary Private Calgary Charter

Outside Calgary Outside Alberta Outside Canada

Was the student suspended or expelled from the last school? Yes No
If yes, was the suspension resolved? Yes No

(If the suspension has not been resolved, please see Chinook Administration.)
If the suspension has been resolved, please provide further information.

Chinook Learning Services Student Registration Form

Revision Date: January 15, 2019
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Parent / Guardian Information (if not independent)
Mother Father Legal Guardian Other

Ms. Mr. Miss Mrs. Last Name First Name

Address City

Province Postal Code Country

Home Phone Business Phone Cell Phone

Fax # E-mail

Custody or Guardianship Information (if not independent)

Student lives PRIMARILY with:
Mother Father Both Parents Legal Guardian Other

Ms. Mr. Miss Mrs. Last Name First Name

Note: If a custody order or any other legal document governing the custody or guardianship of your child exists, a copy
of the most recent custody document must be placed in the student record.
Legal Document Name Legal Document Number

Medical Information
Does the student have any medical or physical conditions that may affect his/her attendance at school?

Yes No If Yes, please complete the Student Medical or Physical Condition Form (pdf).

Francophone Eligibility
A student has Francophone Eligibility if - Either parent’s first language learned and still understood is French or Either
parent has received their primary school instruction in Canada, in French or One or more of the parent’s children has
received or is receiving primary or secondary instruction in French in Canada. Does the student have Francophone
eligibility?
Yes No If yes, and you wish to exercise your right, please contact the Conseil Scolaire Du Sud de l’Alberta at
403-686-6998. The Alberta Student Records Regulations require that, if requested, the CBE will provide name,
address, birth date and parent’s name of eligible students to the Francophone School District.

Declaration
I, the undersigned, hereby represent that I have the legal authority to register the student. I declare the information that I
have provided on this form is complete and accurate. I will notify the school of any changes to the information on
this form. I have also read and understand the “School District Use of Personal Information” section attached to this
registration form. A copy of “Important Information for Parents” may be obtained from the school for future reference.

Signature of Custodial Parent / Legal Guardian / Independent Student Registration Date (MM/DD/YYYY)

Chinook Learning Services Student Registration Form

Revision Date: January 15, 2019
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Important Information for Students and Parents
The personal information requested on this form as part of the school registration process is collected under the authority of Alberta’s
Freedom of Information and Protection of Privacy Act (FOIP), the School Act and its regulations, and the Canadian Charter of Rights and
Freedoms, Section 23. This information will be used for the establishment of a student record, determination of residency, for a school
board’s obligation to provide students with an education program that meets their needs, to provide a safe and secure school
environment and other purposes that relate directly to and are necessary for an operating program or activity, including 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 Learning for the purpose of carrying
out programs, activities, or policies under his/her administration (e.g., research, statistical analysis). This information will be treated in
accordance with the privacy protection provisions of the FOIP Act. If you have any questions about the collection and/or the intended
purposes of your personal information, please contact the school principal or the CBE FOIP Office at [email protected], or by mail to The
Calgary Board of Education, 1221 – 8 Street S.W., Calgary AB T2R 0L4.
Students age 18 and older and their parents should refer to: tinyurl.com/Release-Info-Students-Parents

School District Use of Personal Information

The Calgary Board of Education (CBE) is authorized and required under the provisions of the School Act and its regulations, in
accordance with the Freedom of Information and Protection of Privacy Act (FOIP), to collect, use and disclose the personal information
necessary to provide an educational program and ensure a safe and secure school environment for students. Consent is not required
for these purposes. Personal information means recorded information about an identifiable individual that may include but is not
limited to: student name, age, grade, address, phone number, etc. As part of the school’s digital citizenship plan, students will be
taught to limit, and consider the privacy implications, of sharing their personal information online. The following are some examples of
how personal information may be used by the CBE. This list is not intended to be all-inclusive.
§ Student records, report cards, attendance
§ Photographs or videos ( e.g. individual, class, team, club) that feature students and are used within the school
§ School newsletters, school websites
§ Yearbooks, identification cards, library cards
§ Classroom or program assignments and activities
§ Assignment of a CBE Gmail account and the use of educational tools such as Google Apps* for Education, which may require
student information to log-in
§ Parent/guardian contact information for absenteeism, emergencies, etc.
§ Transportation services
§ School-sponsored activities such as fine arts productions, presentations, fairs, celebrations, clubs, sports activities, field trips
§ To determine eligibility or suitability for an award, scholarship, athletic program, etc.
§ Law enforcement and or matters relating to safety and security

* Google Apps for Education (GAFE) are used to communicate and collaborate electronically. GAFE includes Google Drive, Sites,
Groups, Gmail and Calendar. All other public and third party apps are not available through GAFE.

Parent/guardian consent is required for student information to be used for purposes beyond educational programming and student
safety. See the following forms on the CBE website (www.cbe.ab.ca) for more information:
§ Consent for CBE Use of Student Information
§ Consent for Use of Student Information by News Media and Outside Groups

Parents and independent students are under no obligation to provide consent by signing these forms. Consent may be withdrawn at
any time by notifying the school principal in writing. If you have any questions about the collection or the intended uses of this
information, please contact the school principal.

Please note: Photos, videos or images of students attending or participating in school activities (e.g. sporting events, concerts, cultural
programs, clubs, field trips, graduation or other ceremonies), which are open to the public, may be taken by anyone in attendance
without prior consent. The CBE cannot control or prevent the further distribution or use of these photos, videos, images or other
personal information by those who access the information. Information posted online may be transmitted to and stored on servers
outside the CBE, including locations outside of Alberta and Canada. The CBE cannot guarantee protection of information against
possible disclosure resulting from illegal activity or under foreign access laws.

Chinook Learning Services Student Registration Form

Revision Date: August 31, 2018
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