WELCOME KINDERGARTEN STUDENTS TO CLAVET SCHOOL!
Please find attached your registration package for the 2015-2016 academic year.
Included in this package are a Registration Form, School Information Form,
Special Requests, Bus Service Request Form and a School Calendar. Please complete
the necessary items and either return to us by mail or drop them off at the school.
I know the thought of entering school is a very exciting time for young children and
their parents. Please contact us if you have any questions about the process and
expectations. Although we don’t have a winter open house, we can set up opportunities
to tour the school and meet the teacher.
Closer to the end of this academic year, you will be contacted by the kindergarten
teacher and additional information will be sent out to you. We also will be having an
“Open House” which will allow you to meet with the teacher and familiarize yourself
with the school.
We would like to welcome you to our school and we will look forward to a fun and
rewarding year!
Sincerely,
Mr. B. Matisz, Principal
Mr. P. McTavish, Vice Principal
Ms. K. Maki, Vice Principal
Entry Grade: _____
Prairie Spirit School Division No. 206
Clavet School
Registration Form
Please complete the information below before leaving the school/office. It is required information for
Federal and Provincial funding. A copy of proof of student’s legal name and age is required at initial
registration – Birth Certificate (preferred), Passport, Health Card, Landed Immigrant Documents.
General
Student’s Legal Name
Last
(Last, First, Middle)
Home Address (Street, Apt/Suite or Land
Location City, Province, Postal Code )
First
Middle
Land Location (if Rural) or River Lot (if
_____ - _____ - _____ - _ ____ - _____
applicable) i.e. NW-25-14-9-3
Quarter
Section
Township Range
______
Meridian
River Lot
Mailing Address (Box Number or Street,
Apt/Suite, City, Province, Postal Code)
Personal
Home Phone
306-
Date of Birth (mm/dd/yyyy)
Gender
SK Health Number
_________
Primary Caregiver 1 (last name, first
name)
Relationship
Has Custody
Yes
No
School Announcements/Alerts
(if different
Address
than above)
(Min 1 per household)
Primary Caregiver 2 (last name, first
name)
Relationship
Yes
No
Has Custody
School Announcements/Alerts
(if different
Address
than above)
(Min 1 per household)
/
/ ______________ Type of Documentation Provided _______________________________
Female
Male
_________
Name
Lives with Student
Work Phone
306Home Phone 306Home Phone
Employer
Cell Phone 306Cell - Text
Email
Email
Yes
Cell - Voice
‘
Name
Lives with Student
Work Phone
306Home Phone 306Home Phone
Employer
Cell Phone 306Cell - Text
Email
Email
Yes
(mm/dd/yyyy)
Language Spoken Most at Home
Yes
English
French
No
Date _________/ _________/ 20_________
German
Other Specify__________________________________________
First Nation Specify _____________________________________
Second or Additional Languages
Immigration Status (Please check
Citizen
Refugee1
applicable)
Immigrant 2
Temporary Resident 3
Aboriginal Status (Please check at least
one)
Does Not Apply
Inuit
Metis
Non-Status Indian
Treaty/Registered Status Indian (If Treaty, please provide Treaty Number)
Indian Registry (Treaty) Number
Band of Residence (Band Code)
Beardy’s & Okemasis (369)
Mistawasis (374)
Reserve within Prairie Spirit School Division on
which the student lives. If not living on one of the
listed reserves please select Does Not Apply.
Muskeg Lake (375)
One Arrow (373)
White Cap (372)
Does Not Apply
Reserve Residency
On Reserve 4
(If On Reserve, please provide home address or land location above)
Off Reserve 5
Authorized signature ___________________________________________________
No
Cell - Voice
Citizenship (Federal and Provincial requirement for funding purposes)
Saskatchewan Residency
No
Date_____ / _____/ 20_____
Note
1. Refugee: Refugees (also called ‘protected persons’) are individuals whose seek protection from harm
or life-threatening circumstances in their former country. These students have not been enrolled in a
school within Canada before.
2. Immigrant: An immigrant student is a permanent resident and has long term status in Canada but has
not yet become a Canadian citizen. These students have not been enrolled in a school within Canada
before.
3. Temporary Resident: A temporary resident has come to Canada legally for a temporary purpose (such
as to study, work or visit) and does not have Canadian citizenship. These students have not been
enrolled in a school within Canada before.
4. On Reserve: A student is considered on reserve when they live at a civic address on a reserve.
5. Off Reserve: A student is considered off reserve when attending a public school and living in the
community of the school.
Entry Grade: _____
Homeroom _____ (School Use)
Clavet School
School Information Form
Please complete the information below in addition to the Student Registration Form
General
Student’s Legal Name
Last
First
Middle
Student’s Preferred Name
Last
First
Middle
Student’s Alternate Name(s)
Last
First
Middle
(Last, First, Middle)
Personal
Student Cell
Student Email
Family Rep (Youngest at this school)
Social Insurance Number (optional, may be
306Yes
No
requested for students taking Career and Work Ex courses)
Siblings (Full Name, Birthdate, PreSchool or Current
School)
1
2
3
4
Last, First, Middle Name
Date of Birth (mm/dd/yyy)
School Name or Preschool
Last, First, Middle Name
Date of Birth (mm/dd/yyy)
School Name or Preschool
Last, First, Middle Name
Date of Birth (mm/dd/yyy)
School Name or Preschool
Last, First, Middle Name
Date of Birth (mm/dd/yyy)
School Name or Preschool
Medical
Doctor Name / Phone
Medical Alert (medical conditions that may be life
Name
306-
Number
Name
306-
Number
threatening, ie. EpiPen, diabetic, epileptic, severe allergy, etc.)
Medical Information/Allergies
Medications (Administered at school)
Dentist Name / Phone
Additional Contacts (in addition to those listed on the Registration Form)
In an emergency situation when we cannot reach you, please list people who have agreed to take responsibility for your child and consented to the
release of their phone and address information so we may reach them as an alternative to calling you, the parent or guardian.
Contact 3
(last name, first name)
Relationship
Has Custody
Yes
No
Home Address (if different than Student’s
Name
Work Phone
Home Phone
306306-
Relationship
Has Custody
Yes
No
Home Address (if different than Student’s
Name
Work Phone
Home Phone
306306-
Relationship
Has Custody
Yes
No
Home Address (if different than Student’s
No
Lives with Student
Employer
Cell Phone 306-
Yes
No
Yes
No
Email
Home/Mailing Address )
Contact 5 (last name, first name)
Yes
Email
Home/Mailing Address )
Contact 4 (last name, first name)
Lives with Student
Employer
Cell Phone 306-
Name
Work Phone
Home Phone
306306-
Lives with Student
Employer
Cell Phone 306Email
Home/Mailing Address )
In-Town Billet
In an emergency situation where rural busses are not safely able to return your child home, please list a person who lives in town, has agreed to take
responsibility for your child and consented to the release of their phone and address information so we may reach them.
Billet Contact Information (last name, first name) Name
Relationship
Home Phone 306-
Cell Phone 306-
Work Phone 306-
Home Address (Street, Apt/Suite or
Land Location, City, Province, Postal Code )
Other Considerations
Please indicate if the school to be aware of other considerations, such as learning, physical, psychological, visual, hearing or other
disability or if a Guardian Alert is required. Provide details and documentation to appropriate school personnel
Other Considerations
Guardian Alert
Single Parent Household
School Information
Bus Route, Bus Number, Bus Stop (if known)
Bus Driver Name (if known)
Bus Contact Phone Number (if known)
Bus Type (if known)
Previous School Name
Previous School Phone
Previous School Address
Route
Number
Stop
306In-Town
Rural
306-
Student Consent
Please read the Student Consent Descriptions and initial your authorization for each section. Provide signatures in appropriate areas.
Student Records
Policies
Photography
Media Coverage
Websites
Internet Use
Supporting
Agencies
Student record of marks, (documents relating to assessment, evaluation and progress) will be retained.
I have read the policies provided, related to each of the Permissions indicated below.
Yes
I give permission for Prairie Spirit School Division to create photographs, video records or
Yes
audio recordings of my son/daughter.
I hereby authorize Prairie Spirit School Division to include my son/daughter in media
Yes
coverage such as newspaper, radio or television.
I hereby authorize Prairie Spirit School Division to include my son/daughter on the Prairie
Yes
Spirit website or the school website.
I give my child permission to use the network/Internet as outlined by the guidelines. I
Yes
understand that I may withdraw this permission if I wish.
I give permission to Prairie Spirit School Division to share my son/daughter’s demographic
Yes
information with supporting agencies.
Student’s Home Phone Number
School Directory
(if applicable)
I give permission to publish the following information in
the school directory that is distributed to each family?
(grade 12 only)
I consent to the release of information as outlined. With
regards to media coverage of our graduation, I give
permission for photos to be included in the local media in
the following form(s).
No
No
No
No
Newpaper, Print and On-line
No
No
No
No
Name release for political
congratulations
Yes
No
Student Signature (if 16 or older) _________________________________
Date_______________________
Parent/Guardian Signature __________________________________
Date_______________________
(for students under 18 years of age)
No
Yes
Yes
Yes
Yes
Parent/Guardian Email Address 1
Parent/Guardian Email Address 2
Graduation
No
SPECIAL REQUEST FOR KINDERGARTEN
If there are sufficient registrations, the kindergarten will be split into two groups. Please
indicate below if you have any specific conditions that the school should be aware of
when determining the classes. Examples of factors could be:
 Babysitting concerns or group activities
 Friends/neighbour children who travel together
Every effort will be made to accommodate placement decisions based on this
information.
Prairie Spirit School Division
BUS TRANSPORTATION REQUEST
Please return completed form to Prairie Spirit School Division
Fax: 374-2862 or e-mail: nancy.matechuk@spiritsd.ca
School Requested: ____________________________ Bus Request Start Date: _______________ 20 ______
Parents/Guardians Name(s) & Relationship to student:
_______________________________________________
Mailing Address:
_____________________________________________________________________________
____________________________________________________________________________
Home Phone & Cell Nos.: _______________________________
Work Phone Nos.:
____________________
Legal Land Description (Rural): ______________ - ________________ - ____________ W of ________
(Include NE, NW, SE or SW with section number)
(township)
(range)
(meridian)
Rural: Please draw your driveway and home location on the diagram of a 1 square mile section of land to
show where the school bus will access your property. Please label applicable street, road, or highway names
or numbers.
Is your driveway accessible for a bus to turn around in? ____________
←One Mile Section→
Street Address (Urban):
_____________________________________________________________________
(Include street address, town or subdivision as applicable)
Alternate Emergency Contact Name and Relationship to Student: _________________________________
Alternate Emergency Contact Phone: _______________________________________________________
STUDENT INFORMATION:
Name: ____________________________________ Grade: _____ Allergies/Special Needs:
Name: ____________________________________ Grade: _____ Allergies/Special Needs:
Name: ____________________________________ Grade: _____ Allergies/Special Needs:
Name: ____________________________________ Grade: _____ Allergies/Special Needs:
Name: ____________________________________ Grade: _____ Allergies/Special Needs:
___________________________________________________
Signature
If Applicable
___________
___________
___________
___________
___________
_____________________________
Date
Office Use Only
Bus Route: ____________________________ Driver: _____________________________________________
Comments: ________________________________________________________________________________
Clavet Composite School
Mr. Brian Matisz, Principal
brian.matisz@spiritsd.ca
Mr. Paul McTavish, Vice Principal
paul.mctavish@spiritsd.ca
Ms. Kathy Maki, Interim Vice-Principal
kathy.maki@spiritsd.ca
Box 5, Clavet, SK S0K 0Y0
Phone: 306-933-1022
Fax: 306-933-1048
Pursuing success for all
A respectful community of life long learners
No Child Without
Free MedicAlert Membership for Students at Our School
The Canadian MedicAlert® Foundation has developed a program to protect children and provide
school officials with the help they need to address concerns about students living with chronic medical
conditions, allergies or special needs.
This program is called No Child Without. It was developed to ensure children across Canada from
Junior Kindergarten up to their 14th birthday receive MedicAlert® protection at no cost to the parent,
school or Board of Education. The program follows the child should they move to another school in
Canada. There is a significant benefit to the school because No Child Without blends in with the
school’s safety plan and illustrates the importance of children’s health and safety.
As a national charitable organization, MedicAlert has been protecting people for 45 years through
customized medical identification. Over one million Canadians have chosen MedicAlert to provide
them with protection and peace of mind in case of a medical emergency.
During the school day, students can come in contact with up to five adults responsible for their care
and safety. Before and after school programs, recess, lunch and the classroom are often the
responsibility of different individuals.
In case of a medical emergency, children can be the most vulnerable because they are often too young,
too afraid or too hurt to express themselves. That is why parents often feel better knowing their
children’s MedicAlert identification can speak for them if they’re not around.
The program is being funded by the Canadian MedicAlert Foundation, Lions Clubs across Canada,
grants from the Government of Canada and corporate and local businesses.
Students receive a choice of a bracelet or necklet listing their medical conditions, allergies and or
medications with their identification number, a wallet card, access to the 24-hour Emergency Hotline,
notification of personal emergency contacts at the time of emergency and a follow-up with parents
after the emergency call is made to the Hotline.
No Child Without brochures can be obtained from the school office. If you choose to participate in the
program, contact MedicAlert directly after obtaining the brochure. Your child’s MedicAlert
identification and wallet card will be sent to you within two to three weeks.
If your child is already a member of MedicAlert, call MedicAlert directly to transfer your child to the
No Child Without program.
Visit www.nochildwithout.ca to learn more about the program.