ST. THOMAS COMMUNITY CHRISTIAN SCHOOL
Junior and Senior Kindergarten
ENROLMENT APPLICATION
Please circle: JK or SK
STUDENT INFORMATION
NAME _____________________________________
(last name)
__________________________________________
(given names)
ADDRESS _____________________________________________________________________________
POSTAL CODE __________________________ PHONE NUMBER ________________________________
DATE OF BIRTH ______________________________________________ SEX _____________
day / month / year
PROOF OF AGE: (Provide photocopy of Birth Certificate; Passport) ___________________________
Canadian Citizenship : Yes ____ No ____
If ‘No’: VISA ______ Yes _____ No Please provide photocopy.
HEALTH CARD NUMBER __________________________________________________________________
FAMILY DOCTOR: ________________________________ Telephone No.: ___________________________
NUMBER OF: Older: Brothers ______ Sisters _______ Younger: Brothers _______ Sisters ______
NAME AND ADDRESS OF PREVIOUS SCHOOL ATTENDED (If applicable): _______________________
_____________________________________________________________________________________
PARENT INFORMATION
Father
Mother
Last Name
Guardian(s)
(maiden)
First Name
Citizenship (provide
Photocopy)
If multiple parental residences are involved, indicate when and how we are to address correspondence
regarding school activities and student progress (e.g. newsletters, report cards). Please include full names and
addresses:
Name (s): _______________________________ Name (s): _____________________________________
_______________________________
Address: ________________________________
_____________________________________
Address: ______________________________________
________________________________
School Correspondence Particulars:
□ Send home with student (or mail
when necessary) addressed to the
above mentioned parent(s).
______________________________________
School Correspondence Particulars:

Send home with student (or mail when
necessary) addressed to the abovementioned parent(s).
Church Affiliation: __________________________ Language spoken at home: ______________________
St. Thomas Community Christian School respects your right to privacy and is committed to upholding the
confidentiality and security of all your personal information that you have given to us. However, there are times
that we would like to publish information for the purposes of the smooth running of the school. The following
purposes are identified below.
 Bus cancellation list
 School cancellation list
 Committee member list
 Parent telephone directory
 London District Christian High School
 Photographs of student for use in school publications, OACS publications, local newspaper or on
school’s website (names will not be used on the website to identify students).
Please indicate where you would NOT like your personal information published.
Tell us about your child: Please answer the following questions to enable us to better understand and help
your child.
1.
Have you noticed anything unusual in the growth and development of your child, including speech and motor
development (ie. creeping, crawling, walking)? If yes, please explain. ______________________
____________________________________________________________________________________
____________________________________________________________________________________
2.
Is there anything you wish to share about your child's character and/or social-emotional behaviour?
(i.e. shy, aggressive, fearful, etc.) ________________________________________________________
____________________________________________________________________________________
3.
Do you have any suggestions for us to make your child's experience a good and positive one?
____________________________________________________________________________________
____________________________________________________________________________________
4.
Are there any special health problems we should be aware of? (such as epilepsy, diabetes, asthma, heart
problems,
allergies,
special
medication,
vision,
hearing)
Please
list.
____________________________
____________________________________________________________________________________
____________________________________________________________________________________
5.
Please list the care or schooling your child has had (home school, day-care, pre-school).
____________________________________________________________________________________
6.
Has your child attended special classes for development delay prior to enrolling in Junior Kindergarten?
____________________________________________________________________________________
7.
What are some of your child’s favourite games or play toys? __________________________________
____________________________________________________________________________________
8.
Does your child have any fears that we should know about (ie. dark, closed doors, etc.)?
____________________________________________________________________________________
9.
Other comments? ____________________________________________________________________
____________________________________________________________________________________
Signature: ___________________________________________ Relationship to child: ____________________

Please include a non-refundable enrolment fee of $50 to cover administration. This fee will be
deducted from your tuition.
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ST. THOMAS COMMUNITY CHRISTIAN SCHOOL SOCIETY
STUDENT ENROLMENT AGREEMENT
As Christian parent(s), I / We:
understand the unique nature of this Christian School Society, as expressed in its statements of purpose,
vision, and mission, and as practiced in its daily operation.
sincerely desire to have my/our child(ren) receive a Christ-centered education at STCCS.
agree that my/our child(ren) shall be educated in a manner consistent with the beliefs and objectives of
STCCS.
am/are aware of the Board’s policies regarding enrolment and discipline.
agree that the enrolment of my/our child(ren) is subject to administrative approval.
agree to accept the financial and organizational obligations of enrolling my/our child(ren) in STCCS.
understand that my/our child(ren)’s enrolment is separate from society membership. Membership may be
obtained by making application to the Board, and upon its approval.
understand that I/we have access to normal channels and processes available to all parents and students
regarding the daily educational program at STCCS.
agree to abide by all Board decisions.
_______________________________________________________
Full Name
_____________________________
__________
Relationship to child (ren)
______________________________________________________
Signature:
_____________________________
__________
Date
______________________________________________________
Full Name
_____________________________
__________
Relationship to child (ren)
______________________________________________________
Signature:
_____________________________
__________
Date
================================================================================
Please complete the following if child (ren) have multiple parent/step parents
__________________________________________________ ____________________________________
Full Name
Relationship to child (ren)
__________________________________________________ ____________________________________
Signature:
Date
__________________________________________________ ____________________________________
Signature:
Date
-3ST.THOMAS COMMUNITY CHRISTIAN SCHOOL - FAMILY INFORMATION SHEET
Student’s Name:___________________________________________________________________ Grade:
_________
Last Name
First Name
Date of Birth (dd/mm/yy) ______________________
Gender: M / F
Health
Card#___________________________
Telephone - Home: _______________________ Father / Mother Cell Phone
#:__________________________________
Father’s Name: ___________________ Employer: _________________________________
Tel.:___________________
Mother’s Name: __________________ Employer: ________________________________ Tel.:
___________________
Emergency Contacts:
Name:
Relationship:
Home Telephone No.
Work Telephone No.
Do all those listed in the Parent Information and Emergency Contacts Section have permission to pick up your
child?
Yes _____ No ____
Please inform the office as soon as possible of any change in custody
or permission removal. If you wish to give permission to individuals not in the above sections, please
contact the office for verbal permission or list in the space provided.
____________________________________________
In the event school closes early, and I cannot be reached, my children will walk home _____ or go to:
Name: _________________________________________________ (relationship to family)
______________________
Address: _____________________________________________________Telephone:
___________________________
======================================================================================
ALLERGY and ANAPHYLACTIC REACTIONS:
My child's ALLERGY is:
__________________________________________________________________________
Type of Allergy: ___ drug ___ food ___ animal ___ insect ___ pollen/dust ___ other: ______________
Does your child carry an EpiPen: __________
If your doctor has recommended medication to be given to alleviate allergy symptoms, please specify:
_______________
Have you provided the school with any medication?
___ Yes
___ No
Does your child wear a medic alert bracelet/necklace?
___ Yes
___ No
ASTHMA ALERT:
Does your child have any activity restrictions?
No _____
Yes_____ (Please specify: ___________________________)
Please list your child's medications: pills / inhalations / puffers
______________________________________________
Does your child have a puffer at school? ________ Does your child wear a medic alert bracelet/necklace?
__________
======================================================================================
If, in the case of illness or accident to my child, and when I or my emergency contact cannot be reached by phone,
I authorize the Principal to arrange to have my child taken to the Emergency Department at the Hospital.
Also, I give permission to call for an ambulance if the situation is deemed a necessity, and to use my
child's Health Card Number.
Date: ___________________________ Signature: _____________________________________________
(Original to be filed in OSR; Copy to be kept in office and filed by grade to use on class trips, etc. )