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StrongStart Registration
Student Information
RegistrationID
Student Number
*
School Location
*
Thompson StrongStart
Gender
*
Male
Female
Date of Birth
*
*
Legal First Name
*
*
Legal Middle Name
*
Legal Last Name
*
*
Usual Called Name
*
Document Upload
Student’s Original Document (Proof of name and age)
*
Canadian Birth Certificate
Immigration Canada Document
Passport
Permanent Resident Card
Address Information
Apartment/Unit#/Suite
*
House Number (e.g. 12345)
*
*
Street Name (e.g. Granville, No. 3, etc)
*
*
Street Type
*
Avenue
Bay
Boulevard
Court
Crescent
Drive
Gate
Highway
Lane
Parkway
Place
Road
Station
Street
Way
City
*
*
Province
*
*
Postal Code
*
*
Home Phone
*
*
Mailing Address (if different)
Mailing Apartment/Unit#/Suite
*
Mailing House Number
*
Mailing Street Name
*
Mailing Street Type
Avenue
Bay
Boulevard
Court
Crescent
Drive
Gate
Highway
Lane
Parkway
Place
Road
Station
Street
Way
Mailing City
*
Mailing Province
*
Mailing Postal Code
*
Parent / Caregiver Information
Child Living Status
Both
Mother
Father
Other (please specify)
Other Details
*
First Parent First Name
*
*
First Parent Last Name
*
*
First Parent Relationship to child
*
*
First Parent Phone
*
*
First Parent Email
*
*
*
Second Parent First Name
*
Second Parent Last Name
*
Second Parent Relationship to Child
*
Second Parent Phone
*
Second Parent Email
*
*
Emergency Contact Information
Contact Relationship
*
Contact First Name
*
Contact Last Name
*
Contact Home Phone
*
Contact Cell Phone
*
Contact Language Spoken
*
Contact Email
*
*
Student Medical Information
Doctor Name
*
Doctor Phone
*
Dentist Name
*
Dentist Phone
*
Care Card Number
*
Allergies or Health Conditions
*
Life Threatening
Life Threatening
No
Life Threatening
Yes
Medications
*
Personal Information Consent Form
Section 1: Use of Student Information
School and District Publications and Websites
Staff and students create and publish a variety of materials that highlight school activities, school programs and personal accomplishments. We require your permission to include student information in these materials. Please note that internal sites are also protected by a user ID and password and are not accessible to the public. If you do not provide consent, the student will not be included in publications such as: • Accomplishments/samples of their schoolwork • Newsletters, presentations and reports
School and District Publications and Websites
No
School and District Publications and Websites
Yes
News Media
The school and school district occasionally receive requests from the news media to interview, photograph or video individuals or groups of students. Additionally, news media sometimes attend school functions to publicize athletics, arts or school events. Your permission is required to include student information in these news stories. Please note: Staff cannot control news media access and photos/videos taken by the media and the general public at public locations. Public events are outside provincial and federal privacy laws for public bodies.
News Media
No
News Media
Yes
School and District-Managed Social Media
The school and school district use social media to improve how we communicate information, news and special events to students, parents and the community. The personal information of students that are posted on these platforms can include, but is not limited to, photographs, videos and names. Your permission is required to include student information on social media.
School and District-Managed Social Media
No
School and District-Managed Social Media
Yes
Section 2: Use of Parent Contact Information
District Use
The district would like your consent to send important electronic communication such as district and board updates. This communication may also contain promotions such as: • Early Learning Program Opportunities and Events
District Use
No
District Use
Yes
Signature For Consent and Acknowledgment
Consent or non-consent provided is valid from the date this form is signed until September 30 of the following school year or if a revised signed consent form is submitted, whichever comes first. You may resubmit a revised consent form to your school at any time should you need to change your consent. Preschool students do not need to sign this form. I am the parent/guardian of the student named above, and confirm that I have made the choices above regarding the use of personal information.
Signature For Consent and Acknowledgment
No
Signature For Consent and Acknowledgment
Yes
Declaration Information
Print Name
*
*
Declaration Date
*
*
Status
Pending
Verified
Registered
Cancelled
Expired
Upload Documents
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