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Lloydminster Catholic School Division

“A commitment to faith and a tradition of academic excellence"

St. Mary's Student Registration

Please fill out the following form completely and to the best of your knowledge. Once submitted a member of our staff will be in touch to confirm registration and answer any questions you may have. 

St. Mary's is an elementary school with programming for Kindergarten to Grade 7.

The primary mandate of Catholic Schools is to provide a faith-based Catholic Education for families of the minority faith (Catholic). However, in alignment with our belief that Catholicity is inclusive, both Catholic and non-Catholic students shall be admitted to Lloydminster Catholic School Division upon meeting the following criteria: Prospective students and their parents must agree to follow the policies, procedures and practices of the Lloydminster Catholic School Division. This expectation applies to faith-related activities in particular, but may also apply to any action where beliefs in the school division differ from those of the general public.

Please note: children registering for Kindergarten must be 5 years old by December 31 of the school year that they will be starting Kindergarten.

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St. Mary's Registration

Grade*
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Registration*
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Student Information

Student Legal Last Name*

(as shown on birth certificate)

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Student Legal First Name(s)*

(as shown on birth certificate)

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Student Legal Middle Name(s)

(as shown on birth certificate)

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Preferred Last Name

(if different than above)

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Preferred First Name(s)

(if different than above)

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Preferred Middle Name(s)

(if different than above)

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A copy of the student’s birth certificate or citizenship documentation is required for proof of legal name, age, and citizenship.

Date of Birth*
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Gender*
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Home Phone (not cell phone)
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Select Residence Type*

Civic indicates city/town addresses; rural indicates acreages and farms. Legal Land Location is required for rural properties in the format shown when Rural is selected.

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Physical Address*

Provide apartment / house / street information, as applicable.

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City/Town*
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Province*
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Postal Code*
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Mailing Address

Provide box number or other applicable mailing information.

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City/Town
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Province
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Postal Code
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Mailing Address*

Provide box number or other applicable mailing information.

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City/Town*
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Province*
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Postal Code*
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Land Location
Quarter Section*
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Section*
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Township*
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Range*
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Meridian*
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Medical Information

Indicate specific medical conditions your child may have which require the attention or services of school personnel.

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If your child requires medical attention at school, refer to AP 316. Complete the required forms and provide them to your child's school.

School History

Last School Attended
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Telephone
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Town/City
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Province
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Postal Code
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Country
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Has student ever attended another Lloydminster Catholic School?*
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If yes, indicate name of school.
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Has student ever attended school in Alberta, including Lloydminster?*
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Has student ever attended school in Saskatchewan, including Lloydminster?*
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Parent/Guardian Information

If there are more than two parents or guardians (step-parent, etc.), it is important to provide the school with this information.
Parent 1
Last Name*
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First Name*
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Catholic*
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Relationship to Student*
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E-mail Address*
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Telephone
Cell*
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Work
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Extension
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Home - if different than Cell
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Address

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City/Town
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Province
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Postal Code
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Lives with student*
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Receive mail/email*
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Contact Priority*
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Parent 2
Last Name
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First Name
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Catholic
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Relationship to Student
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E-mail Address
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Telephone
Cell
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Work
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Extension
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Home - if different than Cell
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(###)###-####

Address

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City/Town
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Province
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Postal Code
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Lives with student
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Receive mail/email
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Contact Priority
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Parent 3
Last Name
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First Name
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Catholic
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Relationship to Student
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E-mail Address
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Telephone
Cell
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(###)###-####

Work
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(###)###-####

Extension
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Home - if different than Cell
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(###)###-####

Address

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City/Town
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Province
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Postal Code
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Lives with student
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Receive mail/email
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Contact Priority
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Parent 4
Last Name
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First Name
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Catholic
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Relationship to Student
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E-mail Address
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Telephone
Cell
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(###)###-####

Work
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(###)###-####

Extension
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Home - if different than Cell
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(###)###-####

Address

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City/Town
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Province
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Postal Code
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Lives with student
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Receive mail/email
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Contact Priority
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Guardianship, Custody, or Access Rights

Guardians of the student must be identified to ensure each party’s rights are respected. If an order affecting guardianship rights or custody or access rights exists, a copy of the order will be placed on the student record. In rare instances, a child may be designated as “protected” if a court order has been issued under the Child Welfare Act, the Domestic Relations Act, the Divorce Act or the Young Offenders Act.
Does any such order or agreement affecting the safety, security, custody, or access of the child exist?*
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If yes, arrange to meet with the school administration. Legal documentation will be required.

Additional Contact Information

Emergency Contact

(someone other than parents)

Last Name*
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First Name*
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Relation to Student*
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Telephone
Cell*
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(###)###-####

Work
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(###)###-####

Extension
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Home - if different than Cell
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(###)###-####

Address*
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City/Town*
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Province*
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Postal Code*
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Emergency Contact

(someone other than parents)

Last Name
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First Name
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Relation to Student
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Telephone
Cell
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Work
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Extension
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Home - if different than Cell
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Address
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City/Town
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Province
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Postal Code
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Babysitter/Daycare
Last Name
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First Name
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Or
Daycare Name
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Telephone
Cell
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Work
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Extension
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Home - if different than Cell
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Address
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City/Town
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Province
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Postal Code
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Billet Information For Students Residing Outside Lloydminster City Limits

In the event buses are unable to run, we require a billet home within Lloydminster city limits for your child.

Indicate who would be responsible for billeting your child.

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If Additional Contacts are not residents of Lloydminster, provide the name and contact information of a Lloydminster resident.
Last Name
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First Name
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Telephone
Cell
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Work
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Extension
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Home - if different than Cell
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(###)###-####

Address
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City/Town
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Province
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Postal Code
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Sibling Information

Provide information regarding siblings of the student who are of school age or younger.

Sibling's Full Name
Date of Birth
School Sibling Attends

(if applicable)

Lives with Student

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Citizenship of Student

Citizenship*

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Check the appropriate box to indicate the required document provided to the school to support citizenship.

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Check the appropriate box to indicate which required document has been provided to the school to support citizenship.*
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Issue Date*
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Expiry Date*
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Check the appropriate box to indicate which required document has been provided to the school to support citizenship.*
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Issue Date - Child Document*
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Expiry Date - Child Document*
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and

*

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Issue Date - Parent Document*
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Expiry Date - Parent Document*
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Language

First Language spoken*

(as a toddler)

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Second Language spoken

(if applicable)

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Program

Does your child have any physical, intellectual, behavioral, or emotional needs which may require additional educational assistance, modification, or adaption beyond the regular educational program?*
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If yes, describe the needs of your child in the space below.

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Indigenous Declaration

If you wish to declare that your child is an Indigenous person, please specify one of the following.

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AB Education and the SK Ministry of Education collect this personal information pursuant to section 33(c) of the Freedom of Information and the Protection of Privacy (FOIPP) Act as the information relates directly to and is necessary to meet Ministry and School Board mandates and responsibilities to measure system effectiveness over time and develop policies, programs and services to improve Indigenous learner success. This information will also be used to determine the provincial First Nations, Métis and Inuit Funding Allocation provided to school jurisdictions. For further information or if you have questions: AB residents: http://www.alberta.ca/first-nations-metis-or-inuit-student-self-identification.aspx or AB Education 780-427-8501. Questions related to collection of information by the school board, contact our division office at 780-808-8585. SK residents: write to Lloydminster Catholic School Division at 6611B 39 Street, Lloydminster, AB, T9V 2Z4, or call 780-808-8585.

Religion of Student

The Education Act, 1995 stipulates that every person who has attained the age of six years but has not yet attained the age of twenty-two years has the right to attend school in a school division. It also stipulates that students have a right to secure instruction appropriate to their and level of educational achievement.

"Parents who have the primary and inalienable right and duty to educate their children must enjoy true liberty in their choice of schools."
Congregation for Catholic Education (Vatican) May 5, 2009

Catholic school divisions exist to provide a distinctive Catholic faith-based education. The faith and value dimensions of the Catholic faith are expected to permeate all aspects of instruction and school activities. Schools are expected to exhibit an atmosphere of prayer and be centres of gospel virtues.

Catholicism supports the belief that all parents are their child's primary educators. Parents not of the Catholic faith who desire a Catholic education for their children must be respectful of the teachings of the Catholic Church and agree to abide by the policies and procedures of Catholic school divisions relating to religious instruction and the permeation of faith within all aspects of the student's school experience. However, Catholic school divisions reserve the right to deny admission to a non-Catholic student who will not abide by the policies of the Board relating to religious instruction, religious activities and other such programs specific to our schools.

With this in mind, indicate which statement applies:

 

Catholic Declaration*
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Freedom Of Information And Protection Of Privacy Act (FOIPP) – Parental Consent

Occasionally, schools publish, in a variety of formats, student names, photographs, achievements, etc. for education, instructional, informational, or promotional purposes. It is important for us to be informed of your wishes regarding division and media coverage of student achievements, photographs, and activities during the time your child is a student within our school division. The Freedom of Information and Protection of Privacy Act (FOIPP) requires that parents/guardians control the manner in which student information is displayed, distributed, or published. By checking “I do” below, you will be consenting to the following uses of student information, but not limited to:

  • Student names attached to their art work or written material that are displayed in school division facilities
  • Individual photos that are taken and used within the school, communications, yearbook
  • Photos and/or videos of classroom and school activities that are included in the yearbook and/or displayed in school division facilities
  • Team or class photos used within school division facilities or yearbook
  • Posting of photos, videos, names of student involved in school-based activities (i.e.: sports, graduation, school interviews, etc.), on social media (Facebook, website, etc.), and/or within the local media
  • Student names and description of activities that are used in the school newsletter or other communications
  • Student participation in video-conferences and subsequent recordings to be used for educational purposes

The above listing has been summarized. For the complete document, see the FOIPP Act at the following link.

http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/F22-01.pdf

*

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The school may not restrict photos and/or videos of public school events taken and used for purposes within and outside of the school.
Parent Name*
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Date
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Signature
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Network - Parent Permission And User Agreement Form

Parent Agreement:

I have read AP 145 “Network Services: MAN/Internet Access” and AP 158 "Technology/Online Acceptable Use". I understand that this access is designed for educational purposes. Lloydminster Catholic School Division has taken precautions to eliminate material. However, I also recognize that it is impossible for Lloydminster Catholic School Division to restrict access to all controversial materials and I will not hold the Board of Education of the Lloydminster Catholic School Division or any of its officials or employees responsible for materials acquired on the network. Further, I accept full responsibility for supervision if and when my child’s use is not in a school setting. I hereby give permission to issue an account for my child and certify that the information contained on this form is correct.

 

Parent Name*
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Date
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Signature
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Student Agreement (students in grades 5 through 12 are to sign this area):

In consideration of the Lloydminster Catholic School Division permitting me, the undersigned student (User) to have access as a User of the Internet Service described above, I hereby acknowledge and understand the above Internet terms and conditions and I agree to comply therewith and be bound thereby. I further understand that any violation of the guidelines may constitute a criminal offence. Should I commit any violation of the law or contravene any term or condition set out above, my access privileges may be revoked, school disciplinary action may be taken, and/or appropriate legal action may be taken against me.

Student Name*
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Date
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Signature
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Disclosure

Lloydminster Catholic School Division may use the information collected on this form to assist in providing appropriate educational programming and support for the student. Lloydminster Catholic School Division uses screening procedures in Speech and Language and Occupational Therapy for Kindergarten students. Contact information is collected to help us communicate effectively with the student’s parents or guardians. Some of this demographic data may be shared with Ministries we work with to provide services to our students (including, but not limited to, Education and Health). How this information is accessed, used, or disclosed is protected under the Freedom of Information and Protection of Privacy Act and the Local Freedom of Information and Protection of Privacy Act.

Declaration

I declare that the information I have provided on this registration form is complete and correct. I hereby affirm that I have read this form and understand how the information collected will be used. As indicated by my signature below, I consent to have the information provided by me accessible as indicated and to abide by the philosophy, policies and regulations of the Lloydminster Catholic School Division.

Signature
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Date
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Request for Cumulative Record Transfer

The following student has enrolled at St. Mary's Elementary School. Forward the cumulative record and any other relevant educational information that may be of assistance. Include a copy of this request with the cumulative record.

Important information as we are a Saskatchewan school:

  • SK schools, provide the SK Learning Identification Number. Send the original cumulative record.
  • AB schools, if cumulative record is not available on PASIprep, send a copy, not the original.
  • All other provinces, send a copy of the cumulative record.

Thank you for your assistance.

Student Information

Legal Last Name(*)
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Legal First Name(s)(*)
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Legal Middle Name(s)
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Preferred Last Name

(if applicable)

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Preferred First Name(s)

(if applicable)

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Date of Birth(*)
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Date of Request (office only)

SK Learning ID
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AB Student Number
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Previous School
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Previous School Address
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Previous School Phone Number
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Previous School Fax Number
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