Brock Elementary School- New Student Inquiry

Application for which DDSB School Grade? *

What school year are you applying for? *

Student First Name *

Student Last Name *

Status in Canada? *

Date of Birth (Calendar goes to 2014, click on a random date in 2014 and the previous years will show) *

Date of Entry into Canada (If the student has studied overseas more then one year)

Health Card Number *

Does the child have any health conditions? Please provide details and details on any medication? (If none, please write none) *

Does the child have a learning challenge or disability? Please provide details (if none, please write none) *

Any other special conditions the school should be made aware of? (if none, please write none) *

Last 2 schools the student has Attended. Please type out Name of School and board, what Grade and what year (school 1 of 2) *

Last 2 schools the student has Attended. Please type out Name of School and board, what Grade and what year (school 2 of 2) *

Has the applicant ever been expelled from any school in Ontario? *

Does the applicant have an IEP (Individual Education Plan)? *

Has the applicant undergone any enrollment in any additional educational assessment for learning exceptionalities? *

Has the applicant undergone any enrollment in E.S.L or H.S.P Math and Language Support Program? *

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Email Address *

Parent/Guardian 1 Phone Number *

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email Address

Parent/Guardian 2 Phone Number

Parent Custody *

Address *

Emergency Contact Name (Please inform the person(s) that they are listed as an emergency contact for BES) *

Emergency Contact Number *

Parent / Guardian Signature *

Submission Date *

Captcha *

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