New School Age Registration Form

Kimberley Independent School

NEW Student Registration Form
Please print clearly and complete entire form.
Registration date:

MonthDayYear
Date
Enrollment date:

MonthDayYear
Date
Were you referred to us by a current KIS family? Please tell us who!
Please share the parent's first and last name
Please let us know if you are interested in/wanting to register for the following programs:

BeforecareAftercare
Proof of BC Residency: (Must be provided before enrollment)

Parent / legal guardian BC Care Card or BC Services CardParent / legal guardian BC Driver's license or ID cardBC rental or tenancy agreement (must display full name and legal address)BC property purchase agreement (must display full name and legal address)BC utility bill (must display full name and legal address)Other
Proof of Age Received and on file:

BC IdentificationBirth CertificatePassportCourt OrderImmigration DocumentationOther
Previous School Name:*
School Name
Previous School City & Province:*
OR StrongStart Program in BC?

Yes
Fees Paid:

RegistrationSupplyVolunteer Dep.
STUDENT INFORMATION
Legal Name:*

First NameMiddle InitialLast Name
Preferred Name:

First NameMiddle InitialLast Name
Date of Birth: (DD/MMM/YYYY)*

DayMonthYear
Date
Grade:*
Gender:*

MaleFemaleOther
Main Phone:*
Property/Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address same at Home Address?

Yes
Mailing Address (if different than Home Address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IMMIGRATION/CITIZENSHIP/INDIGENOUS ANCESTRY
Country of Birth:*
Language at Home:*
Do you have Indigenous Ancestry?:*

YesNo
Indigenous Ancestry Details:

MetisInuitStatus - off reserveNon-statusStatus - on reserve
Band of residence:
Status Card # (if applicable):

Status in Canada: Please fill in for both Parent and Child

	Child	Parent
Canadian Citizen
Permanent Resident/Landed Immigrant
International Student
Student Visa

Tuition Payment and Registration Agreement
By submitting your registration and supply fees, you have committed to one full school year of tuition payments at our school. As a small independent school, that only receives 50% of Ministry of Education Government funding compared to the public system, most of your tuition funds go directly to paying our teachers and staff and to cover basic school operations. The remaining funds and fees you pay (along with any government grants or fundraising) enable us to ensure all of our students are provided with high-quality programs, activities enrichment and learning materials. It is critical that we work together to ensure the success and sustainability of our school for all students and families. Late or returned payments negatively impact all children at our school.
Parent/Guardian: By signing below you acknowledge that:
1. The annual tuition is based on a 10-month school year. Tuition may be paid in a yearly lump sum or monthly payments. The first payment will be due September 1^st and the last payment due June 1^st. Monthly payments are due on the first of each month.
2. When you register, the expectation is that you have enrolled your child for one full school year. Withdrawing mid-year is strongly discouraged and fees for the remainder of the school year will be due at the time of withdrawal (subject to situation).
3. Payments that are over 60 days past due negatively impact the operation of the school and a warning will be issued. Without immediate remediation, the parent/guardian may be subject to additional fees/penalties OR may be subject to student dismissal.
4. DEDUCTIONS: No deductions will be made for days, weeks or months absent from school for any reason, including but not limited to: illness, behavior-related suspensions, vacations, withdrawals, or government-mandated school closures. Full tuition must be paid in order to maintain student enrollment.
5. REFUND POLICY: All payments completed are NON-REFUNDABLE.
I have read, understood and agree to all the above terms.
Printed name of Parent/Guardian:*
Signature of Parent/Guardian:*

Clear
Date:*

MonthDayYear
Date

Registration Fee Payment

Please fill in your credit card details here for a secure payment.

Pay by Credit Card*

School Age Program Registration Fee Product Image

School Age Program Registration FeeFee for Initial Registration into KIS School Age Program, includes processing fee. Non-refundable.

$105.00CAD

Enter coupon

Total

$0.00CAD

Credit Card

Should be Empty:

	Sibling 1	Sibling 2	Sibling 3	Sibling 4
Last Name
First Name
Relationship
Date of Birth (dd/month/year)
School

	YES	In Past Year
Allergy/Hives
Asthma
Convulsions
Diabetes
Dizziness/Fainting
Ear/hearing issues
Encephalitis
Epilepsy
Eye/vision issues

	YES	In Past Year
Fractures
Frequent Headaches
Frequent Stomach Issues
Heart Disease
Hepatitis
Mononucleosis
Urinary Tract Infections
Other: (Please Explain Below)

Kimberley Independent School

STUDENT INFORMATION

IMMIGRATION/CITIZENSHIP/INDIGENOUS ANCESTRY

PARENT/LEGAL GUARDIAN INFORMATION

CUSTODY (MUST BE COMPLETED):

EMERGENCY CONTACT INFORMATION

PERMISSIONS & RELEASES

KIS Medical Information Form

Medical History:

Allergies:

Learning Support/Alternative Programs:

Tuition Payment and Registration Agreement

Parent/Guardian: By signing below you acknowledge that:

Registration Fee Payment

Credit Card

	Allergy Name	Expected Reaction	Medication and Action Plan
1.
2.
3.