Sir Winston Churchill Secondary School
Grade. 8 Student Registration Form
Current School: ___________________________________
Student No.: _________________________
Neighbourhood High School:
Applying for Grade: ________ School Year: _________
Section A – Student Information
Legal Name: ________________________________________
LAST
_________________________ _________________________
FIRST
MIDDLE
Usual Name: ________________________________________
LAST
_________________________
FIRST
Home Phone Number ______________________
Gender:
□ Male □ Female
Address:
City:
Country/Province of Birth:
Citizenship Status (circle one):
Birth Date: ______________________
dd-mmm-yyyy
Language:
Postal Code: _______________
Language at Home: __________________
Canadian Citizen | Landed Immigrant | Work Permit | International Student
Aboriginal Ancestry: □ Yes □ No
If YES, would you like to receive Enhanced Educational Services?
Access to Internet? □ Yes □ No
□ Yes □ No
Release of Photo for School Purposes? □ Yes □ No
Section B – Parent/Guardian Information
Siblings attending Churchill (if any) ____________________________
□ Male □ Female
Birth Date: ______________________
Mother/Guardian Name: _____________________________
Father/Guardian Name: ______________________________
Relationship to student: _________________ (If not mother)
Relationship to student: _________________ (If not father)
Living with the student:
□ Yes □ No
Address (if NO): ___________________________________
Copy of correspondence:
□ Yes □ No
Living with the student:
□ Yes □ No
Address (if NO): ____________________________________
Copy of correspondence:
□ Yes □ No
Home Phone number: _____ - _____ - ________
Home Phone number: _____ - _____ - ________
Cellular Phone number: _____ - _____ - ________
Cellular Phone number: _____ - _____ - ________
Work Phone number: _____ - _____ - _________
Work Phone number: _____ - _____ - _________
Email Address: _______________________________
Email Address: _______________________________
Section C – Emergency Contact Information (Other than parents/guardians in Section B)
Name: _________________________________________
Name: _________________________________________
Relationship to Student: ___________________________
Relationship to Student: ___________________________
Language Spoken: _______________________________
Language Spoken: _______________________________
Home Phone number: _______ - _______ - ___________
Home Phone number: _______ - _______ - ___________
Cellular Phone number: _______ - _______ - __________
Cellular Phone number: _______ - _______ - __________
Work Phone number: _______ - _______ - ___________
Work Phone number: _______ - _______ - ___________
Any other pertinent contacts (i.e. Social Worker, etc.)? __________________________________________________________________
Section D – Medical Information
Doctor:
Phone Number: _________________ Care Card Number:
Allergies or Health Conditions:
Life Threatening? □ Yes □ No
(If YES, please ask Office Staff for an Emergency Care form for you to complete).
Section E – Grade 8 Programs (Every student gets a set of Core Courses, and must select ONE of the Electives)
Core Grade 8 Courses (English & Synergy):
Core Grade 8 Courses (French Immersion):
English 8
French 8
Mathematics 8
Science 8
Social Studies 8
Applied Skills 8
(MEN—08)
(MFR—08)
(MMA--08)
(MSC--08)
(MSS—08)
(XAT--08AS) (Home Economics,
Technology, and Business Ed)
Physical Education 8 (MPE—08)
English 8
FI Language 8
Mathematics 8
FI Science 8
FI Social Studies 8
IF Communications 8
Physical Education 8
(MEN--08)
(FFRAL08)
(MMA—08)
(FSCF-08)
(FSCHF08)
(FFRAL08COM)
(MPE—08)
Electives – Please indicate your order of preference by filling in 1, 2, and 3 in the form below.
English Student:
French Immersion Student:
Fine Art 8
( XAT--08FA)
Fine Art 8
(XAT--08FA)
Orchestra 8
(MMU—08STR)
Orchestra 8
(MMU—08STR)
Chorus 8
(MMU—08CHO)
Chorus 8
(MMU—08CHO)
Band Beginners (MMU--08B; No Experience)
Band Beginners (MMU--08B; No Experience)
Band Junior
Band Junior
(MMU—08JR: Elementary Band)
(MMU--08JR Elem Band)
Applied Skills 8 (XAT--08AS)
COMPLETE THE FOLLOWING IF CHOOSING BAND OR ORCHESTRA (Please see Band Information at school website)
Instrument Choices (List up to 3 instrument choices):
Band
1.
2.
3. ______________________
Orchestra 1.
2.
3. ______________________
Do you read music?
(Circle) YES
NO
What instrument have you had training on (if any)? ____________ For how long? _____________________
What instrument do you own (if any)? ___________________________
Section E – Please Attach Copies of the Following Registration Documents:
Birth Certificate
Most Recent Report Card
Proof of Residency (2 pieces)
Primary documents: Recent Property Tax Notice; Purchase Agreement; Utility /Cable /Land Phone Bill
Secondary documents: e.g. Vehicle Registration, Recent Bank Statement, etc.
Student’s Signature: ___________________ Parent/Guardian’s Signature: _______________________
Date: _______________________