Student Registration Form - Calgary Board of Education

Revised April 2015 Page 1 | 5
DECLARATION OF RESIDENCY
The student named below is a resident of the Calgary Board of Education as defined by the School Act. Yes No
See Student Residency and Important Information for Parents on page 4 of this form.
Has the student named below ever registered in a Calgary Board of Education (CBE) school? Yes No
If yes, name the last CBE school attended
Last Grade
Completed
School Withdrawal Date
CBE Student ID Number
Alberta Education ID Number
YYYY MM DD
The student’s Birth Certificate, Canadian Citizenship Certificate, Passport, Visa, Permanent Landed Immigrant document or other official document
must be given along with this form in order to register. A photocopy will be placed in the Official Student Record.
Name of official document (specify)
Student’s Legal Name
Student’s AKA Name (name by which the student
is commonly known in the family and community)
Birthdate
Surname AKA Surname
YYYY MM DD
First Name AKA Given Name
Middle Name
Address
City
Postal Code
Phone Number
Unlisted
Listed
Quadrant of City (please select one)
NW NE SW SE
Residential District
Gender
Male
Female
MEDICAL INFORMATION
(Note: The CBE is not allowed to collect Alberta Health Care numbers as per the Health Information Act.)
If the student’s attendance at school may be affected by an existing medical or physical condition, it is your responsibility to complete and submit the
Does your child have any medical or physical conditions that may affect his/her attendance at school? Yes No
If yes, please give a brief description
Have you completed the Student Health Plan? Yes No
SCHOOL INFORMATION
Name of school at which student is registering
Grade Entering Start Date
YYYY MM DD
Name of last school attended
Reason for leaving last school
Grade Completed
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, CBE staff will refer to Student Services-Suspensions)
If the suspension has been resolved, provide further information.
Address of last school (If outside CBE)
City
Province
Postal Code
Country
Phone number of last school
Fax number of last school
Office Use Only SIRS Fees Codes Request Records
Student Registration Form
Student Information Records System (SIRS)
This form must be completed for all new students who are registering in a
Calgary Board of Education (CBE) school (K-12).
CBE ID #:
Program:
Full-day Kindergarten: Yes No
Address Verified: Yes No
Entered by: Date:
STUDENT INFORMATION
(Please print)
YYYY/MM/DD
Student Health Plan that is available from the school or online at www.cbe.ab.ca.
Page 1/8
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