Student Registration Form STUDENT REGISTRATION FORM Thank you for your interest in Harmony Public Charter School. This Registration and Enrollment Form is used to collect the information required to support the admissions process and, if accepted, establish your child's student record. Please complete all required fields and review each consent carefully before submitting your application. Fields marked with an asterisk (*) are required. 1. Student Information Legal First Name * Middle Name Legal Last Name * Preferred Name Date of Birth * Grade Applying For * KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6 Alberta Student Number (if known) Citizenship Canadian CitizenPermanent ResidentRefugeeStudy PermitOther Country of Birth Primary Language Spoken at Home Additional Languages Spoken Student Address Street Address * City * Province * AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code * Mailing Address is same as Residential Address Mailing Address City Province Alberta Postal Code 2. Parent/Guardian Information Parent/Guardian #1 Full Legal Name * Relationship to Student * Mother Father Guardian Grandparent Other Phone * Alternate Phone Email * Address * Lives with Student? * Yes No Authorized for Pickup? * Yes No Parent/Guardian #2 Full Legal Name Relationship to Student Mother Father Guardian Grandparent Other Phone Alternate Phone Email Address Lives with Student? Yes No Authorized for Pickup? Yes No Custody and Guardianship Are there any custody, guardianship, parenting or access restrictions? * Yes No If yes, please explain. 3. Emergency Contacts Emergency contacts should be individuals other than the parent(s)/guardian(s) listed above and must be available to assist in the event that a parent/guardian cannot be reached. Emergency Contact #1 Full Name * Relationship * Phone * Alternate Phone Authorized for pickup? * Yes No Emergency Contact #2 Full Name Relationship Phone Alternate Phone Authorized for pickup? Yes No 4. Medical Information Alberta Health Care Number * Family Doctor Name Doctor Phone Number Does your child have allergies? * Yes No If yes, please describe Does your child have any medical conditions? * Yes No If yes, please describe Does your child require medication at school? * Yes No If yes, please describe Additional medical requirements: EpiPen Required Inhaler Required Medical Plan on File 5. Educational Information Current/Previous School School Division Last Grade Completed Has your child previously received any of the following supports? IPP Learning Support Speech Services Occupational Therapy Psychological Assessment Behaviour Support Other Additional educational information 6. Consents and Authorizations Please review the following authorizations and consents. Certain consents are required to support your child's enrollment, safety, communication, and participation in school programs and services. Technology Consent I understand that students may be provided access to school-approved technology, digital learning platforms, internet resources, and educational software as part of their educational program. I acknowledge that students are expected to use technology responsibly and in accordance with school expectations. I acknowledge and consent to my child's use of school-approved technology and digital learning resources. Communication Consent I consent to receive communications from Harmony Public Charter School regarding my child's education, attendance, student progress, school events, transportation, emergency notifications, newsletters, and other school-related matters. I understand that communications may be delivered by email, telephone, text message, school applications, or other approved communication methods. I consent to receive communications from Harmony Public Charter School. Student Information Consent I understand that Harmony Public Charter School collects, uses, and maintains student information for educational programming, student safety, transportation, communication, reporting requirements, and student record management as authorized under applicable Alberta legislation. Information will be protected and managed in accordance with applicable privacy legislation and school authority procedures. I acknowledge the collection and use of student information for educational and operational purposes. Emergency Medical Authorization In the event of a medical emergency and if a parent or guardian cannot be reached, I authorize Harmony Public Charter School to obtain appropriate emergency medical treatment for my child. I understand that reasonable efforts will be made to contact a parent or guardian as soon as possible. I authorize emergency medical treatment if a parent or guardian cannot be reached. Media Consent From time to time, Harmony Public Charter School may photograph, record, or showcase student participation in school activities, events, projects, publications, newsletters, social media, promotional materials, and the school website. Student names will not be published with photographs without additional consideration and school discretion. Please indicate your preference regarding the use of your child's image, voice, schoolwork, or participation in school-related media. * Yes, I consent No, I do not consent Please contact me prior to any use Charter School Acknowledgement Harmony Public Charter School operates under an approved charter and provides a structured, culturally responsive educational program rooted in Africentric philosophy, academic excellence, community partnership, and student responsibility. By selecting the acknowledgement below, I confirm that I have reviewed and understand the school's charter, educational approach, and expectations for students and families. I understand that active parent partnership and support are essential components of the Harmony Public Charter School community. I acknowledge that I have read, understood, and support the mission, philosophy, and expectations outlined in the Harmony Public Charter School Charter and agree to participate as an active partner in my child's education. 7. Parent/Guardian Declaration I certify that the information provided in this enrollment package is accurate and complete to the best of my knowledge. I understand that it is my responsibility to notify Harmony Public Charter School of any changes to contact information, guardianship arrangements, medical information, emergency contacts, or other information relevant to my child's education and safety. * I certify that the information provided is accurate and complete. Parent/Guardian Full Name * Date * Electronic Signature (Type Full Legal Name) * Submit