Student Registration Form - 2024-2025 School Year



School Registration

Student Data


Home Address

Mailing Address

Guardian Info

Emergency Contacts Information

If a parent or guardian is unavailable, list persons authorized to care for the child in case of an emergency. Please ensure that the person(s) are aware that their name has been used. 

Student Medical information

In the event of an emergency when I am not available, I authorize the administration of any medical procedures deemed necessary by my doctor, or by any other physician selected by the Designate of the school. I also authorize the school to provide or allow the provision of Health Care to my child, only upon written consent of the child’s parent, or the Health Care provided is in the nature of First Aid/CPR

Services Information

Alternate Residence

Student Services Data

Kainai Child Protection Services Data


List any siblings name and age



The use of audio and/or visual recording methods for diagnostic, therapeutic, or educational purposes occurs only with full knowledge of the purpose by the client and guardian, and with their written approval. The written approval will describe the intended use of the recording. Parents/Guardians will be contacted by the school for separate written consent in the following instances: audio and visual taken where the material will be used outside of the program, release of student names outside of the program, copyright for artwork or creative writing which will be reproduced for use outside the program, or used on the school website, and acceptable use of IT services and hardware. Names WILL NOT be published with any pictures.


I have read and understand the uses that will be made for the personal information as listed above, and I hereby certify that the information provided by me on the registration form is true, correct and complete to the best of my knowledge and belief.