checklist for the maples registration gr. 1- 8 2019...

CHECKLIST FOR THE MAPLES REGISTRATION Gr. 1- 8

2019 - 2020

$500.00 New Family Enrollment Fee

Balance of Tuition* (post-dated cheques, depending on payment plan choice)

Fully Completed and Signed Admission Application

Registration Agreement

Health History Form

Pick-up Permission Form (parents must be listed on this form)

Photo Permission Form

Payor’s Authorization Form for Preauthorized Debit (if applicable), and a VoidCheque

New Student Enrollments also need to include:

Permission to Release School Records to The Maples

Proof of Age (ie Birth Certificate, Passport)

Copy of Immunization Record

Immunization Form

Total Submitted: $____________

* Payable by Cash, Credit Card (Plastiq), Pre-Authorized Debit, or Cheque(s)to The Maples

513047 2ND LINE • AMARANTH • ONTARIO • L9W 0S3 • 519.942.3310

Student’s Name: Female Male

Birthdate: DD / MM / YY Commonly Used Name:

Application for Grade: for the school year beginning September,

Father’s Name:

Address: City: Postal Code:

Occupation: Bus. Title

Business Name:

Bus. Address: City Postal Code:

Mother’s Name:


Occupation: Bus. Title

Business Name:

Bus. Address: City Postal Code:

If parents are separated or divorced, please indicate with whom child is living: Mother Father

Present School: Grade:

School Address: City: Postal Code:

Principal: Telephone:

ADMISSION APPLICATION2019 - 2020

In accordance with PIPEDA, your personal information will be used solely for communication purposes regarding The Maples.

This form should be completed by Parentor Guardian and sent to:

The Maples513047 2nd LineAmaranth, Ontario L9W 0S3

Home Phone:

Cell:

Email:

Bus. Phone:

Bus. Cell Phone:

Bus. Email

Home Phone:

Cell:

Email:

Bus. Phone:

Bus. Cell Phone:

Bus. Email

Signed (Mother) Signed (Father) Date:

*Please enclose copies of student’s previous Report Card(s), completed Health Information Sheet, Registration Agreement, Birth Certificate and Immunization Card.The completed Immunization Card must be received prior to September. Upon acceptance of student, please submit a recent family photograph.

REGISTRATION AGREEMENT

In consideration of the acceptance by The Maples of

Name of Student

as a student, we agree to pay all tuition fees, deposits, dues, accounts and other indebtedness incurred by the student or on thestudent’s behalf. We understand that the obligation to pay the tuition fees for the full academic year is unconditional and that no portion of such fees so paid or outstanding will be refunded or cancelled in the event of absence, withdrawal or dismissal of the above student from the school.

We further understand that:

(a) The fee structure will be as follows:Payment of a onetime family enrollment fee of $500 due upon acceptance of student.Please note this deposit is non-refundable. Please refer to fee schedule for payment structures.

(b) Accounts unpaid for 30 days will accumulate interest at 1.5% per month or part thereof frombilling date to date of payment.

(c) No student will be admitted for an academic year if any indebtedness to The Mapleswith respect to the previous academic year remains unpaid, including interest.

(d) Should any outstanding accounts exist, the re-registration deposit may, at the option ofThe Maples, be credited towards any outstanding accounts.

Please note that re-registration and re-enrollment of the student will not proceed until all accounts are settled and paid in full

Signature of Parent or Guardian who is financially responsible for the student:

Signature: Date:


Signature: Date:


Please note that this document is to be considered only as an application for registration unless and until the above student has beem accepted and such acceptance is con�rmed by receipt of your deposit


PERMISSION TO RELEASE SCHOOL RECORDSTO THE MAPLES

Student’s Name: Grade:

Parent School:

I grant permission to the proper authorities at:

to release a copy of the following parts of my child’s record to The Maples in the following Confidential School Report:

• Official Administrative Record (name, address, birthdate, grade level completed,grades, class standing, attendance record)

• Standardized Achievement Test Scores

• Intelligence and Aptitude Test Scores

• Teacher and/or Counselor Observations and Comments

• Family Background Data

Other:

Signature of Parent or Guardian: Date:


First Name: Middle Name: Last Name:

Birthdate: Height: Weight:

Please briefly comment on your child’s overall health:

If your child is not able to participate in certain athletic and school activities, please outline:

Has your child ever had his/her eyes tested by a vision specialist: Yes No

Explain Result:

Has your child ever had his/her hearing tested by a specialist: Yes No

Explain Result:

Does your child have frequent: Colds Tonsilitis Stomach Aches High Fevers

Does your child have any allergies:

Briefly explain child’s reaction to any of these allergies and any medication taken for these:

Does your child have a diagnosed condition:

Does your child have any congenital problems/issues:

Is your child receiving a medication program:

Thank you for answering these questions. We hope this will better enable us to meet your child’s needsand make his/her days at The Maples pleasant and productive.

Signature of Parent or Guardian: Date:

HEALTH HISTORYAssessments dated within 6 months of school are requested.

Immunization CardA completed immunization card must besubmitted prior to beginning of school year.

EMERGENCY INFORMATION Please give the name of someone, other than the parent or guardian, who can be contacted in case of an emergency:

Name: Relationship:

Emergency Phone Numbers:

Name of Physician: Address: Telephone:

Child’s Health Card No.

___________-___________-___________-______

Expiry Date:__________________________


Pick-up Permission Form

I hereby give permission for my child(ren)

to leave The Maples with the following people named below.

It is my responsibility to notify the school in writing of any change.

1. Name:

Address:

Telephone: Relationship:

2. Name:

Address:


3. Name:

Address:


4. Name:

Address:


5. Name:

Address:


Parent or guardian signature: _______________________________ Date: _______________


Photo Permission Form

Throughout the year, The Maples’ students participate in activities, events or projects in

which students may be photographed or videotaped. This includes but is not limited to

school portraits, student projects, field trips or special events. Please fill out this form,

marking a “yes” or “no” for each section. If a choice is not made, we will

assume your answer is, “yes”.

Student name:______________________________________ Grade: __________________

I give permission for my child ________________________________ to appear in the

following: (please initial Yes or No for each)

___Yes ___No In School Displays – including but not limited to bulletin boards,

class-made books, or student multi media projects; students may be

identified by first and last name.

___Yes ___No Other School Publications – including but not limited to students

publications. Students may be identified by first and last name.

___Yes ___No Outside Publications – including but not limited to the Orangeville Banner;

students may be identified by first and last name.

___Yes ___No Internet – including but not limited to main pages, class pages,

or special events pages. Students will not be identified by name.

Parent or guardian signature: ________________________________ Date: _____________



Payment OptionsGrade 1 - 8

Plan

1 Full payment $10,965

2 4 Post dated cheques or automatic debit April 1, July 1, October 1, January 1 $2,741.25

3 12 Post dated cheques or automatic debit April 1 - March 1st $913.75

*2nd and subsequent siblings $10,149

checklist for the maples registration gr. 1- 8 2019...

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