Application for Enrolment (DL)

STUDENT INFORMATION

Legal Name

(as shown on the student's birth certificate)

First: *

Middle: *

Last: *

Usual Name

(if different)

First:

Middle:

Last:

Demographics

Date of birth: *

Place of birth: *

Gender: *

Citizenship: *

Present school grade: *

School grade applying for: *

Requested admission date: *

Aboriginal Ancestry: *

Yes

If yes:

Aboriginal Status:

Band #:

Contact Info

Phone: *

Fax:

Email: *

Home Address
(Street, City, Province and Postal Code): *

Mailing Address, if different
(Street, City, Province and Postal Code):

Medical Info

Allergies and other medical details: *

Care Card: *

Emergency Contact (name & phone): *

Family Doctor (name & phone): *

PARENT/GUARDIAN INFORMATION

Father (Guardian)

Full Name: *

Home Phone: *

Cell Phone:

Occupation: *

Work Phone:

Email address: *

Relationship to student: *

Address, if different from student
(Street, City, Province and Postal Code):

Mother (Guardian)

Full Name: *

Home Phone: *

Cell Phone:

Occupation: *

Work Phone:

Email address: *

Relationship to student: *

Address, if different from student
(Street, City, Province and Postal Code):

Other

Please indicate the legal guardianship of your child: *

other custody:

Does your family reside in British Columbia?: *

Are you landed immigrants in Canada?: *

Is your family or child here on a special work or student visa?: *

EDUCATIONAL INFORMATION

Last School

If no previous school, please enter n/a for the following fields.

Name:

Location (city & province):

Phone #:

Last date attended:

Last grade:

Type of school:

Reason for changing:

Academic History

In your opinion, does your child need any special learning assistance or tutoring in any core academic subjects (Reading, Writing, Arithmetic)?: *

In your opinion, does your child excel beyond their grade level in any of the core academic subjects (Reading, Writing, Arithmetic)?: *

If "yes" for either of the above, please explain:

I grant Regent Christian Online Academy permission to request my child’s records and contact my child’s previous schools if necessary : *

Yes

SPIRITUAL INFORMATION

Family Church

Name: *

Location (city & province): *

Phone: *

Pastor contact (full name): *

We attend church: *

Your child

I would describe my child's spiritual experience as: *

spiritually mature for their age

growing and enthusiastic in the Christian faith

very passionate about their Christian faith

a nominal but genuine Christian experience

somewhat resistant to spiritual things

I haven’t observed my child in any spiritual context or experience

Are there any other concerns, spiritual or non-spiritual, that you want to inform the school about? Please explain:

RESOURCE CENTRES

RCOA is unique in that we offer optional weekly Resource Centre classess (in every community we are called to serve) free of charge for our DL students, and for a minimal yearly fee for our HS students. Our goal is to facilitate each child's social experience and growth and give RCOA teachers opportunities to get to know the children they serve in a group environment.

Are you interested in your child attending a Resource Centre class in your area?

RC Yes/No: *

Yes

If yes, please select the Resource Centre location you wish to sign-up for:

Locations: *

FINISHING YOUR APPLICATION

Please mail a copy of the child's birth certificate and the completed residency form (click to download) to:

Regent Christian Online Academy
McKenzie Professional Building
Suite #216, 1595 McKenzie Ave.
Victoria, BC
V8N 1A4

I understand this application is not complete until I have mailed a copy of my child’s birth certificate and a signed copy of the residency form.: *

Yes

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