Registration for K - 9

To be completed by parent or legal guardian (Applicant)

* - Required field

The Applicant confirms that the information in this form is accurate and complete, that the Applicant has the legal right to enroll the student in NIDES, and that the Applicant understands that no materials will be forwarded until fees and deposits (where applicable) are paid; that work required will be completed and returned as directed; and that enrollment remains valid for one year.	I agree
The Applicant confirms the legal guardian, student, and home facilitator’s commitments to working together with NIDES in completing the coursework agreed to by all parties during the normal academic calendar (unless otherwise negotiated). Working together is defined by consistent activity in courses (unless previously agreed to, consistent activity is defined as weekly submissions according to the personal education plan of the student) and continuous communication with the NIDES teachers (weekly).	I agree
The applicant understands that if the student is inactive, he/she may be referred to enroll in a more structured school program elsewhere.	I agree
If using NIDES computers and/or online services, the Applicant agrees that the Internet access only be for educational and lawful purposes.	I agree
The Applicant hereby authorizes the release of all previous records to the North Island Distance Education School, and authorizes North Island Distance Education School to report to schools, school districts, or post-secondary institutions where records exist.	I agree
The Applicant understands that NIDES courses continue to move to online delivery and dynamic online content. Unless otherwise specified, the student will be enrolled in a media-rich, highly interactive online classroom with easy access to teachers and support.	I agree
The Applicant agrees that he/she will submit a copy of the student’s birth certificate.	I agree
The Applicant declares that the student and legal guardian are ordinarily resident in British Columbia, and if traveling outside of the province of BC, the Applicant will inform the registrar (registrar@nides.bc.ca) in writing of their intended return date to British Columbia.	I agree
By completing this form and submitting it, it is assumed that the Applicant agrees to the above conditions of enrollment.	I agree

Questions/Comments:

A. Student Information
*Start Date	September Other, please specify:
*Legal Surname		Usual Surname
*Legal FIRST Name		Usual First Name
*Legal MIDDLE Name	(Enter "none" if student does not have a middle name)	*Gender	Male Female
*Legal MIDDLE Name	(Enter "none" if student does not have a middle name)	*Date of Birth
*Telephone - Home		Fax
Telephone - Work		*Student's Email	(Enter "none" if student does not have email)
*Resident of British Columbia?	Yes No	*Parent/Guardian Email	(Enter "none" if parent/guardian does not have email)
NIDES can accept these students, who currently reside in British Columbia. (Those traveling temporarily outside of BC are eligible.)
*Select the student citizenship status:	Canadian Citizen Landed Immigrant
NOTE: Please make sure to include any PO boxes, suite #’s etc... or any information we will need to ship you materials.
*Home Address		Mailing Address (if different)
*City		City
*Province		Province
*Country		Country
*Postal Code		Postal Code
*First & Last name of Parent/Guardian		*Relationship
		Address & Phone if different from student's
First & Last name of Parent/Guardian		Relationship
		Address & Phone if different from student's
*Adult who will be the student's home facilitator		Home facilitator's email, if different from above
		Home facilitator's phone, if different from above
*First Nations, Metis, Inuit Aboriginal Ancestry?	None Status - On Reserve Status - Off Reserve Non Status Metis Inuit
Medical Information
*Care Card #
*Doctor Name		*Doctor's Phone
*Dentist Name		*Dentist's Phone
*Allergies and Health Conditions	(Enter "none" if there are no allergies or health conditions)	*Life Threatening?	Yes No
Medications: If your child will be bringing required medication to school or to school events, submit Medical Alert and Prescribed Medication Record by fax, mail or drop off to NIDES.
B. Education
*Interaction Day Request:	Nanaimo Courtenay Qualicum None (choose one only)
What is an Interaction Day	Students get together with their teacher and other students on a regular basis (weekly in Nanaimo and Courtenay) for activities and field trips.
*Has student received Learning Assistance?	Yes No	Learning Assistance areas of focus:
*Has student had an Individual Education Plan?	Yes No I Don't Know	If there was an IEP, when was it done? (YYYY-MM-DD)
If your child is new to NIDES, and you have answered yes to any of the above questions, complete and submit this signed release by fax, mail or drop off to NIDES.
*Do you have a computer?	Yes, personal computer Yes, NIDES computer No	*Has there been a Psycho-educational Assessment?	Yes No I Don't Know
Are you requesting a NIDES computer? ($100 deposit required)	Yes No	*Do you have an internet connection?	No Dial-up High-Speed
*Are you currently enrolled at NIDES?	Yes No
*Grade you are applying for:	K 1 2 3 4 5 6 7 8 9
*Grade you last completed:	None K 1 2 3 4 5 6 7 8
*Date last grade completed:		*Name of last school:
*Reasons for withdrawal:	(Enter "none" if student was not at another school)	Location of last school:	(Enter "none" if student was not at another school)