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Information form (parents or guardians)
INFORMATION FORM (PARENTS OR GUARDIANS)
Parent/Guardian 1
Name
*
First name
Surname
Address
*
Address (street, number)
Town
Province
Postal Box
Phone (cell)
*
Phone (home)
Phone (work)
E-mail
*
Role:
*
Father
Mother
Relative
Spouse/Partner of Parent
Legal guardian
Mother tongue:
Knowledge of french :
*
Yes
No
Main language spoken at home :
Parent/Guardian 2
If the "Parent / Guardian 2" section does not apply to your situation, please leave the fields blank and go to the next section.
Name
*
First name
Surname
Address
Address (if different)
Town
Province
Postal Box
Phone (cell)
*
Phone (home)
Phone (work)
E-mail
*
Role:
*
Father
Mother
Spouse/Partner of Parent
Legal guardian
Mother tongue:
Knowledge of French :
*
Yes
No
Main language spoken at home :
SCHOOL-AGED CHILDREN
Number of child(ren):
*
1
2
3
4
This field is hidden when viewing the form
1 child
Child #1
*
First name
Surname
Birth date:
*
MM slash DD slash YYYY
MCP Number:
*
This field is hidden when viewing the form
2 children
Child #2
First name
Surname
Birth date:
MM slash DD slash YYYY
MCP Number:
*
This field is hidden when viewing the form
3 children
Child #3
First name
Surname
Birth date:
MM slash DD slash YYYY
MCP Number:
*
This field is hidden when viewing the form
4 children
Child #4
First name
Surname
Birth date
MM slash DD slash YYYY
MCP Number
*
EMERGENCY CONTACT INFORMATION
The individuals authorized to pick up my child (children) at the school are :
*
Parent/guardian 1
Parent/guardian 2
Other
This field is hidden when viewing the form
May pick up child
Name
First name
Surname
Address
*
Address
Town
Province
Postal box
Relationship to the parents or child (e.g. uncle, grandmother, family friend, etc.):
Phone (cell)
*
Phone (home)
Phone (work)
E-mail
*
This field is hidden when viewing the form
Emergency
In case of emergency, please contact :
*
Parent/guardian 1
Parent/guardian 2
Other
This field is hidden when viewing the form
Emergency
Name
First name
Surname
Address
*
Address
Town
Province
Postal Box
Relationship to the parents or child (e.g. uncle, grandmother, family friend, etc.):
Phone (cell)
*
Phone (home)
Phone (work)
E-mail
*
Language of communication :
*
English
English
This field is hidden when viewing the form
Section Break
Submission of the form acts as a signature to the document. For any questions, please contact us at the following address: ecole-rdn@csfptnl.ca
Date:
*
MM slash DD slash YYYY
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