Section 1: Student Information

Student Name

First Name

Last Name

Student Middle Name

Preferred Name

Date of Birth

YYYY

Current Age

Email Address

Requested Enrollment

If JK/K, please choose one option below:

Part Time

Full Time

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone

(###)

###

####

Business Phone

(###)

###

####

Mobile Phone

(###)

###

####

Employer

Section 2: Contact Information

Parent/Guardian 2 Name

First Name

Last Name

Address

If different than above.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone

(###)

###

####

Business Phone

(###)

###

####

Mobile Phone

(###)

###

####

Employer

Section 3: Medical History

Family Physician:

Phone Number:

Ontario Health Card Number:

Please indicate any medical conditions or allergies below:

Please list any medications your child takes:

Section 4: Student Profile (Education)

Does your child have any special needs or exceptionalities that we should be aware of? If so, please explain below:

Does your child speak another language at home?

Yes

If so, please indicate language:

Has your child previously attended another school?

Yes

If so, please indicate school:

Please provide previous report card along with pre-registration.

Has your child been suspended or expelled from school?

Yes

Does your child have an I.E.P?

If so, please provide a copy along with pre- registration.

Yes

Previous Daycare Provider:

Section 5: Student Profile (Personal)

Do both parents reside with the child

Yes

Number and age of siblings:

Other members of the household:

Is your child able to care for his/her own toileting needs?

Yes

Please use 5 adjectives to describe your child:

List/describe your child’s strengths:

List/describe what your child struggles with or is challenged by:

In space provided, please indicate the hobbies, interest of your child. What does he/she like doing?

What do you hope your child will gain from attending Creekford Academy?

Is there any other information you feel would be useful in helping the teachers better understand your child?

Section 6: Student Interview

As part of the application process the Creekford Academy staff would like to meet, work with, and learn about all perspective students. Once we receive and review this application, staff will contact you to set up a student interview. Please be advised that while we value interactions and communication with parents, they will not be directly apart of the interview. Parents are welcome to explore the property and facilities while we work with their child. Children will have the opportunity to participate in a variety of activities planned by our staff, however we ask that each prospective student bring a personal item to share with our staff. This item should help us to better get to know your child!

Please indicate your preference for an interview time.

Morning

Afternoon

Section 7: Parent Skills Inventory

The skills that our parents bring to the learning community at Creekford Academy are many and varied. They support and strengthen the diverse learning environment that we strive to achieve. It is amazing how many very talented people are connected to our students, and in order to utilize these talents we have developed an inventory of available skills. Creekford Academy is always looking for special guests to share their interests and passions with our students. Perhaps you have a keen interest in other cultures, have visited or lived in another country and have artifacts and knowledge to share. Do you play a musical instrument? Are you artistically talented? Perhaps you are a biologist or are in environmental science and would be a great resource for our school. Maybe you teach yoga or are a fantastic carpenter with skills to share. This in no way obligates you to anything; it simply gives us a point in which to start when looking for different opportunities for our students. Vast and varied exposure is critical to learning and growth, so we hope that you will support us in this endeavor.

Parent Name

Other skills:

Parent Name

Other skills:

Creekford Academy Pre-Registration Form

Please fill out the pre-registration form below
and we will be in contact with you shortly to set up a student visit.

Explore. Learn. Create. Play.

Creekford Academy Pre-Registration Form

Please fill out the pre-registration form belowand we will be in contact with you shortly to set up a student visit.

Explore. Learn. Create. Play.

Please fill out the pre-registration form below
and we will be in contact with you shortly to set up a student visit.