Our Lady of Victory School  

New Student Registration Form (Partial Copy)

PLEASE PRINT

Full Legal Name ___________________________________________________________________________ Gender _______

Applying for Grade ___________ Date of Birth _______________________________ MET No. __________________________

                                                                           Day      Month      Year

Student Address _________________________________________________________________________________________

                                            Street                                         City/Town                                               Postal Code

Currently residing in Public School Division ____________________________________________________________________

Canadian Citizen: ( / ) _____ Yes _____ No   Birth Country (IF NOT CANADA) ___________________________________________

Immigrant: ______ ( / ) Immigration Stamp # _______________ Student Visa ______ ( T ) St. Visa # _____________________

Religion ________ Place of Worship _________________________________ Pastor / Clergyman________________________

Sacraments Received: (MONTH / YEAR) ____________________ Baptism        _____________________ First Communion

                                                            ____________________ Reconciliation ____________________ Confirmation

Previous School (if applicable) _____________________________ Address ______________________________ Grade _____

____ ( /) MOTHER ____ ( /) LEGAL GUARDIAN                                          ____ ( /) FATHER ____ ( /) LEGAL GUARDIAN

_______________________________________________                       _______________________________________________

   Surname                                      Given Name                                                                Surname                                          Given Name

Address ________________________________________                       Address ________________________________________

City/Town ______________________________________                         City/Town ______________________________________

Postal Code ______________ Cell # _________________                            Postal Code ______________ Cell # _________________

Home Ph. # ______________ Work # ________________                            Home Ph. # ______________ Work # ________________

e-mail _________________________________________                            e-mail _________________________________________

Occupation _____________________________________                          Occupation _____________________________________

Employer's Name ________________________________                            Employer's Name ________________________________

Business Address ________________________________                          Business Address ________________________________

Mother's / Guardian's Religion ______________________                            Father's / Guardian's Religion _______________________

Emergency Contact 1:

Name __________________________________________________________ Relationship to Child ______________________

Home Phone No. ____________________ Work Phone No. ____________________ Cell Phone No. _____________________

Emergency Contact 2:

Name __________________________________________________________ Relationship to Child ______________________

Home Phone No. ____________________ Work Phone No. ____________________ Cell Phone No. _____________________

Student lives with: ____ Both Parents        ____ Mother Only         ____ Father Only         ____ Guardian         ____ Foster

Custody:              ____ Both Parents        ____ Mother Only          ____ Father Only         ____ Guardian         ____ Other

School reports / general mailings / notices should be sent to: ____ Parents / Guardians      ____ Mother            ____ Father

School age siblings: _____________________________________________________________________ (NAME / GRADE / SCHOOL)

                          _______________________________________________________________________ (NAME / GRADE / SCHOOL)

                          _______________________________________________________________________ (NAME / GRADE / SCHOOL)

Aboriginal Identity: (Completion optional for Manitoba Education, Training & Youth)

  If Aboriginal, you may select up to 3 identities.

  ____ Not Aboriginal    ____ Aboriginal - Uncertain of Ancestry

____ Anishinaabe       ____ Ininiw (Cree)   ____ Dene (Sayisi)   ____ Dakota

____ Oji-Cree             ____ Michif            ____ Michif-Cree       ____ Michif-French

____ Michif-Ojibway    ____ Inuktituq         ____ Aboriginal - Other   

Volunteer Service for the School :

All Parent(s) / Guardian(s) are required to assist at bingo for two evenings each school year. Parents are also required to sign up for at least one of the following activities:

         _____ In-School Volunteer   _____ PTA    _____ Bingo     _____ Driving    _____ Board Member (elected)

For advertising reasons, please tell us how you heard about Our Lady of Victory School:

         _____ Sign     _____ Community Newspaper     _____ Winnipeg Free Press      ____ Radio     _____ Flyer

         _____ Word of Mouth        Other (please specify) _______________________________________________

Please fax completed form to

Our Lady of Victory School

(204) 453-3081

PLEASE PROVIDE THE FOLLOWING WITH THIS APPLICATION:

1. Your child's most recent progress report (except Kindergarten)

2. Proof of age for Kindergarten (copy of Birth Certificate)

3. Immunization Record

4. $55.00 Registration Fee (Non-Refundable)