ONLINE Private lessons Please complete this form to register to the School. Step 1 of 7 14% Family Contact Details1st Parent/Guardian Name* First Last 1st Parent/Guardian Email* 1st Parent/Guardian Phone Number*2nd Parent/Guardian Name First Last 2nd Parent/Guardian Email 2nd Parent/Guardian Phone NumberHome Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Independent Status*Students 18 years of age and older, or “independent” under the School Act: Any student 18 years of age and older or 16 years of age and older and considered legally “independent” under Slovak School policy may complete this form and register in without parental consent. Proof of independent status must be presented. Yes. I am an Independent Student (Please submit proof) No, I am not Please attach proof of independent status*Max. file size: 8 MB.Number of Student/s being signed up:Please indicate the number of Student/s you will be registering. Please enter “0” if none are being registered. If there are more Students being registered, please do 3 now, and up to 3 again afterwards. The form can only register up to 3 Students at a time. Please enter a number from 0 to 4. First Student Details1st Student's Name* First Last 1st Student's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201st Student's Age* ProgramOnline ClassesOnline Private ClassesIn Person Classes1st Student's Grade 1st Student's Name, Address, and Phone number of Child's last attended school:1st Student's Main Languages Spoken at Home (Please indicate level of Fluency)*1st Student's Gender*Please selectMaleFemaleOther1st Student's Alberta Health Care Number* 1st Student's Known Allergies/medical conditions (Please be as detailed as possible):*Age Group 6-14 years old 15 years old – Adults Language Level Beginner Intermediate Advance Second Student Details2nd Student's Name* First Last 2nd Student's Age* 2nd Student's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119202nd Student's Grade 2nd Student's Name, Address, and Phone number of Child's last attended school:2nd Student's Main Languages Spoken at Home (Please indicate level of Fluency)*2nd Student's Gender*Please selectMaleFemaleOther2nd Student's Alberta Health Care Number* 2nd Student's Known Allergies/medical conditions (Please be as detailed as possible):*Age Group 6-14 years old 15 years old – Adults Language Level Beginner Intermediate Advance Third Student Details3rd Student's Name* First Last 3rd Student's Age* 3rd Student's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119203rd Student's Grade 3rd Student's Name, Address, and Phone number of Child's last attended school:3rd Student's Main Languages Spoken at Home (Please indicate level of Fluency)*3rd Student's Gender*Please selectMaleFemaleOther3rd Student's Alberta Health Care Number* 3rd Student's Known Allergies/medical conditions (Please be as detailed as possible):*Age Group 6-14 years old 15 years old – Adults Language Level Beginner Intermediate Advance Emergency Contact DetailsFirst Emergency Contact Name* First Last First Emergency Contact Phone Number*First's Relation to Student/s* First Contact Authorized to pick up?*YesNoSecond Emergency Contact Name* First Last Second Emergency Contact Phone Number*Second's Relation to Student/s* Second Authorized to pick up?*YesNoFamily Physician Name Family Physician Phone NumberMedical Liability*If the student’s attendance at school may be affected by an existing medical, physical, or emotional condition or medication, it is your responsibility to complete and submit the this to the Student’s Health Plan. I agreeEmergency Agreement* I authorize the school to contact the physician or an ambulance if I cannot be contacted during an emergency: School ApprovalsSchool Declaration:* I, the undersigned, hereby represent that I have the legal authority to register the student. I declare the information that I have provided on this form is complete and accurate. I will notify the school of any changes to the information on this form in timely matter. I have also read and understand the “School District Use of Personal Information” section attached to this registration form. A copy of “Important Information for Parents” may be obtained from the school for future reference. I’m giving permission to take pictures/videos of student during teaching class for purpose of newspapers, brochures, websites to promote school activities.IMPORTANT INFORMATION FOR PARENTS/GUARDIANS* The personal information requested on this form as part of the school registration process is collected under the authority of Alberta’s Freedom of Information and Protection of Privacy Act (FOIP), the School Act and its regulations, and the Canadian Charter of Rights and Freedoms, Section 23. This information will be used for the establishment of a student record, determination of residency, for a school board’s obligation to provide students with an education program that meets their needs, to provide a safe and secure school environment and other purposes that relate directly to and are necessary for an operating program or activity, including program placement, determination of eligibility and/or suitability for provincial or federal funding, contact and health related information in the event of problems or emergencies. Personal information may also be provided to the Minister of Learning for the purpose of carrying out programs, activities, or policies under his/her administration (e.g., research, statistical analysis). This information will be treated in accordance with the privacy protection provisions of the FOIP Act. Payment DetailsSchool Fees:*The annual fee is Individual 1.5-2hr lessons- $30, 2 or 3 students: 1.5-2hr – $20 per student / per lesson. Tuition is payable preferably by e-transfer to email@example.com, Visa, or MasterCard are also another option, NO cheques or cash. Any second student from the same family will receive 10% off of annual tuition, any third or more students from the same family 20% off of annual tuition. Schedule: 3-4 days each month average (Sept to June) (excluding long weekend or statutory holidays) following CBE traditional calendar. I understandHow many Student/s are being signed up?*Prices are described above. 1 Student / per lesson (1.5-2hr) 2 Students / per lesson (1.5-2hr) 3 Students / per lesson (1.5-2hr) Total $ 0.00 CAD Payment Options*Please choose an option to confirm how you will pay for your selection E-Transfer to firstname.lastname@example.org Other. Email email@example.com with an explanation E-Transfer* Please sent an e-transfer from your bank to firstname.lastname@example.org The security question should be “What is this for?” The answer should be “skschoolregistration” Thank you! I have sent the paymentConsent* Please send an email explaining how you would like to pay to email@example.com Thank you! I have sent the EmailPaypal Payment*PayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Your Signature*By signing this document you agree to have the payments for this registration delivered within 5 days of the form’s submission. You are also certifying that all the information provided is true and accurate for all the members involved.CAPTCHANameThis field is for validation purposes and should be left unchanged.