PLEASE COMPLETE THE REGISTRATION FORM HERE (THE ACADEMIC YEAR 2021-2022) * MANDATORY FIELD Order Number STUDENT INFORMATION First Name * Surname * Date of Birth * dd-mm-yyyy Gender * F M Address * Unit Postal Code * City * Province * NL PE NS NB QC ON MB SK AB BC Best Phone# to reach the guardian * Health Card * Primary language spoken * Child lives with: * Both Parents Father Mother Guardian (Please provide the office with a copy of any relevant custody papers) MOTHER INFORMATION First Name * Surname * Cell Phone# * Address * Unit Postal Code * City * Province * NL PE NS NB QC ON MB SK AB BC Email Address * Occupation * Employer * Work Tel * FATHER INFORMATION First Name * Surname * Cell Phone# * Address * Unit Postal Code * City * Province * NL PE NS NB QC ON MB SK AB BC Email Address * Occupation * Employer * Work Tel * GUARDIAN INFORMATION (If other than parents) First Name Surname Work Tel Address Unit Postal Code City Province NL PE NS NB QC ON MB SK AB BC Email Address EMERGENCY CONTACTS First Name * Surname * Relationship * Home Phone Cell Phone Work Phone EDUCATION HISTORY Name of present school: * Present Grade * Address of present school Postal Code Special Needs (list if any) Has your child ever been on an Individual Education Program (IEP)? If Yes, indicate grade level(s) and subject(s) * Yes No Has your child ever been suspended or expelled from school? If Yes, indicate grade level(s), school, and reason: * Yes No ACKNOWLEDGEMENT Registration is not complete until all forms, required documents and applicable registration fee are submitted. Parents will be formally notified of their child’s admission following successful completion of the admission assessment procedures. Parents must sign all forms to complete the registration package Date * dd-mm-yyyy MUNICIPAL FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT: Personal information on this form is collected under the legal authority of the Education Act, R.S.O. 1980, c.129 and Health Card Numbers Control Act, 1991. This information will be used for the purposes of: processing student registration, production of student databases, student placement and referrals, statistical and reporting requirements by the Ministry of Education, a program to students, contacting parent(s), guardian(s), etc, in case of emergency, and the disclosure of health-related information to the Medical Officer of Health. Questions regarding this collection and use of personal information should be directed to the Office. MAC Niagara Islamic School holds the right to open, merge, and/or close classes based on the number of students registered in the class.