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  • Kimberley Independent School

    NEW Student Registration Form

  • Please complete entire form and complete one registration per student. You may refer to our fee guide on our website for details on tuition, fees and payments. The registration fee is payable in order to submit your registration and is NON-REFUNDABLE.

  • Registration date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Enrollment date:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Withdrawal/Transfer Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Withdrawal To:
  • Proof of BC Residency: (Must be provided before enrollment)
  • Proof of Age Received and on file:
  • Fees Paid:

  • STUDENT INFORMATION

  • Date of Birth: (DD/MMM/YYYY)*
     - -
    2 digit day, 2 digit month, 4 digit year
  • Gender:*
  • Format: (000) 000-0000.

  • IMMIGRATION/CITIZENSHIP/INDIGENOUS ANCESTRY

  • Do you have Indigenous Ancestry?:*
  • Indigenous Ancestry Details:
  • Status in Canada: Please fill in for both Parent and Child
    Rows

  • PARENT/LEGAL GUARDIAN INFORMATION

  • Relationship:*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Will receive school emails:*
  • Can Pick Up?:*
  • Lives with student:*
  • Has MyEd Portal Access:*
  • Relationship:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Will receive school emails:
  • Can Pick Up?:
  • Lives with student:
  • Has MyEd Portal Access:

  • CUSTODY (MUST BE COMPLETED):

  • Does the child reside with both parents:*
  • Are there legal documents in force we should know about (re: custody/guardianship/access)? **If yes, please provide a copy of the custody order to the school administration.*

  • EMERGENCY CONTACT INFORMATION

    Note: Parents should contact all emergency contacts listed above to ensure they know they are listed as an emergency contact. Emergency Contacts should be someone OTHER than parent/guardians.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Please Select all that apply:*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Please select all that apply:
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Please select all that apply:
  • SCHOOL AGED SIBLING INFORMATION
    Rows

  • PERMISSIONS & RELEASES

  • Media Release:

  • I consent for my child's name and/or photo to be used in any external school media including classroom updates, marketing publications, webpages and social media and I understand that information posted on the internet may be stored and accessed outside of Canada.*
  • I consent for my child's name and/or photo to be used in any internal school media including the See Saw App, school yearbook, bulletin boards on the school premises and school email newsletters.*
  • Technology Release: I consent for my child to access the network and internet for educational purposes in accordance with school policy (parents may access the policy in the parent handbook). I understand in the event that my child engages in any inappropriate activity, that privileges to access the school network and devices may be revoked and other disciplinary action may result.*
  • Local Excursion Consent: I give permission for my child to participate in out-of-school activities such as outdoor classroom activities and walking field trips within the City of Kimberley limits with the understanding The Board Members cannot assume liability for the damage of personal property or personal injury beyond normal legal responsibilities. While participating in any school excursion, students and staff are governed by all laws and regulations applying to Kimberley Independent School Society.*
  • Permission to Walk Home: I consent for my child to leave Kimberley Independent School premises to walk home. I understand that my child will be walking home unsupervised.*
  • Parent Support Group: I consent for the school to disclose my name, phone number, e-mail address and child's name to the Parent Support Group (PSG) for the sole purpose of school-related communications.*
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • KIS Medical Information Form

  • This form must be completed for each student for each school registration year. You are required to contact the school administration in writing to advise if there are changes to your child's medical status or medications during the school year.
  • *** If your child does not have a regular family physician you must provide the name of the clinic or hospital where your child would go for medical care.

  • Medical History:

  • Has your child ever been subject to any of the following? Please check all that apply.
    Rows
  • Rows

  • Allergies:

  • Does your child have any allergies? (Please include any food, medication, environmental or contact allergies they may have)*
  • Please list the specific allergy and expected potential reaction as well as any medications to be administered.
    Rows
  • Is your child's medical condition life threatening:

  • ** If your child has a life threatening medical condition you must meet with the principal prior to the child attending KIS and ensure a Medical Alert Planning Form has been completed.

  • Learning Support/Alternative Programs:

  • Please indicate if any of the following apply to your child:
  • My Child has an Individual Education Plan (IEP)/Care Plan*
  • My Child was in an alternate program*
  • My Child has a behavioural diagnosis:*
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  • 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 1st and the last payment due June 1st. 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.
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Registration Fee Payment

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

  • Pay by Credit Card*

    prevnext( X )
    School Age Program Registration Fee. Fee for Initial Registration into KIS School Age Program, includes processing fee. Non-refundable.
    School Age Program Registration Fee

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

    $205.00 CAD$205.00CAD
      
    Total
    $0.00 CAD$0.00CAD

    Credit Card
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