New Students | Alfajrul Bassem

Registration for New Students

Student's Information

Student's First Name

Student's Last Name

Child's Grade in Upcoming Year

Student's Birthdate

Gender

Male

Female

Student's Primary Language at Home

English

Arabic

Other

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Born in Canada?

Yes

Birth Country:

Nationality

Arrival Date in Canada

Status in Canada

Student live with:

Both Mother & Father

Mother

Father

Guardian

Medical and Health Information

Health Card Number:

Family Doctor's Name

Doctor's Address

Doctor's Phone Number:

Does your child have any physical medical conditions that the administration needs to be aware of?

Please indicate whether your child has any allergies (including insect bites, medication, food, animals, plants, dust, etc.):

Briefly explain your child’s reaction to any of these allergies:

What counter-measures need to be taken if a reaction occurs?

Is your child receiving any medication on a continuous basis? If yes, please list names and reasons for medication.

Has your child been diagnosed for any behavioural, cognitive, or other disorder affecting his/her ability to learn (e.g. Attention Deficit Disorder (ADD), Asperger Syndrome, Dyslexia)? If yes, please indicate what and how it is treated.

In the Event of Illness and/or Medical Emergencies (Please select all):

I confirm if my child becomes ill while at school, parents must pick the child up or arrange for transportation.

In the event there is an emergency involving my child and the school is unable to contact me or the emergency contact person whom I have advised you in writing, I hereby grant ABA or any member of its staff the permission to call another physician, call an ambulance, or have the child taken to an emergency hospital in the care of a staff member, as you deem appropriate at the time.

I understand and agree that any expenses incurred under the above circumstances, will be the responsibility of the child’s family.

I hereby understand if my child must take a prescription medication at school, I am required to provide a permission form signed by the parent. I understand staff can only administer routine prescribed medication when a written permission is submitted to the school by the parent.

I hereby understand that by signing this health record, I give permission to ABA to release this medical information to the necessary medical emergency personnel if the need arises.

Parents Information

Mother's Full Name

Mother's Email

Mother's Phone #

Mother's Address

Father's Full Name

Father's Email

Father's Phone #

Father's Address

Emergency Contact Name

Emergency Contact Phone #

Emergency Contact Email

Relationship to child

Media Consent

I give permission for my child to be:

Interviewed for publication by school staff or students (newsletters, websites, etc.)

Interviewed for publication by media (newspaper, radio, TV)

Photographed or to appear on video for publication by school staff or students (newsletters, websites, etc.)

Photographed or to appear on video for publication by media (newspaper, radio, TV, etc.)

Photographed or to appear on video for publication by Alfajrul Bassem Academy’s Facebook page, Instagram page and/or Twitter site

School Trip Consent

On occasion, the class may take a nature walk, go to a neighborhood park for exercise, or might take part in other outdoor activities or a short school trip. While we always strive to inform parents about these trips, they are not always planned.

I give my child/(ren) permission to participate in school trips

My child/(ren) cannot participate in school trips

Financial Information

Bank Account Name

Enter New Bank Account #

Enter New Transit #

Enter Financial Institution #

Payment Options:

1 Instalment

10 Instalments (Instalments withdrawn from July 2021 - May 2022)

12 Instalments (Instalments withdrawn from July 2021 - June 2022)

Uniform Size

Select an item (C$)

Technology Fee ($150) + 1 Full Uniform ($100) + 1 Full Active Wear ($100) - C$350

Bus Registration

Select an option

I want to register my child ($185/month)

I do not want to register my child

Student Record Form

Name of previous school

Address of previous school

School phone number:

School email

Student number

Last completed grade

Grade entering ABA

Uploading Files

Upload a copy of the child’s Canadian birth certificate or government issued identification (displaying both name and date of birth), or a document showing immigration status

Upload File

Upload Immunization Record

Upload File

Upload a copy of the child’s health card or a health insurance card

Upload File

Upload copies of the most recent report card(s) available

Upload File

Admission Policies

Please click on the Admission Policies link below and read them carefully

I agree to the terms and conditions ofAdmission Policies

Your Signature

Date Signed

Student's Information

Medical and Health Information

Parents Information

Media Consent

School Trip Consent

Financial Information

Uniform Size

Bus Registration

Student Record Form

Uploading Files

Admission Policies

LOCATION

EMAIL

PHONE

SOCIAL

874 Sinclair Rd, Oakville, ON, L6K 2H3

info@alfajrulbassem.com

+1 (905) 514-9995