1.

Student First Name:

2.

Student Last Name:

3.

Student Street Address:

4.

Student City:

5.

Student Postal Code:

6.

Student Phone Number:

Vital Student Information
Please enter the medical information, conditions, and medical information belonging to the student.

7a.

Current Grade:

7.

Date Of Birth:

8.

Health Card Number:

9.

Child's Doctor's Name:

10.

Child's Doctor's Telephone:

11.

Medical Information:

Please enter any medical
information that relates to the student.  Allergies, medications taken, conditions, etcetera, are examples of medical information.   Use as much space as you need to include full details.

Parental Information
Information about the Mother and Father of the student.

12.

Mother's Full Name:

13.

Mother's Street Address:

14.

Mother's City:

15.

Mother's Postal Code:

16.

Mother's Home Telephone:

17.

Mother's Work Telephone:

18.

Mother's Cellular Phone:

19.

Mother's Other Telephone:

20.

Father's Full Name:

21.

Father's Street Address:

22.

Father's City:

23.

Father's Postal Code:

24.

Father's Home Telephone:

25.

Father's Work Telephone:

26.

Father's Cellular Phone:

27.

Father's Other Telephone:

28.

Family E-mail address:

If you would like to receive classroom newsletters and communicate with the school via e-mail, please enter an e-mail address that is regularly checked here.

Emergency Contact Details
The two nearest relatives or friends who may be contacted when parents cannot be reached in case of emergency.

29.

1st Emergency Contact Name:

30.

Emergency Contact Telephone:

31.

2nd Emergency Contact Name:

32.

Emergency Contact Telephone:

Basic Academic Information
Please list the all of the academic institutions that the student has attended

33.

Hillcrest Starting Date:

34.

1st School Previously Attended:

35.

Previous School Street Address:

36.

Previous School City:

37.

Previous School Start Date:

38.

Previous School End Date:

39.

2nd School Previously Attended:

40.

Previous School Street Address:

41.

Previous School City:

42.

Previous School Start Date:

43.

Previous School End Date:

44.

3rd School Previously Attended:

45.

Previous School Street Address:

46.

Previous School City:

47.

Previous School Start Date:

48.

Previous School End Date:

Permission
Please completely read the following.  Contact the school with any questions.

I hereby grant permission for my child to use all of the play equipment and participate in all the activities of the school.

I hereby grant permission for my child to leave the school premises under the supervision of a staff member for neighborhood walks or for field trips in an authorized vehicle.

I hereby grant permission for my child to be included in all games and
activities with all the other children and will not hold the school responsible for any injuries that may occur from these activities.

I hereby grant permission for the person in charge that day to take whatever steps may be necessary to obtain emergency medical care if warranted.

If we cannot contact you or your child's physician we will do any or all of the following: 1) Call another physician or paramedics.  2) Call an ambulance. 
3) Have the child taken to an emergency hospital in the company of a staff member.

Any expenses incurred for any kind of medical attention, will be borne by the child's family.  The school will not be responsible for anything that may
happen as a result of false information given at the time of enrollment.

49.

You will receive an e-mail confirmation from a Hillcrest administrator when we have received your form.

If you do not receive an e-mail confirmation within 7 days, please contact the school at 519-942-3251.

Please note that you will be required to review the information above at the school.  A parent or guardian (listed above) will be required to sign at that time before the student can start classes at Hillcrest.

Thank-you for registering on-line!

Click the Submit button below to complete the registration form.

50.