SECTION I All applicants must complete this section
Students Full Name:

Civic Address:

Mailing Address:

(if different from civic address)
Home Phone:

(required format: (902)765-0000)
Email Address:

Date of Birth:

Gender:

Hand:

Health Card #:

Expiry Date:

Doctor's Name:

Doctor's Address:

Doctor's Phone:


Any serious illnesses or allergies(past or present):
Child Lives With:

Parent's Marital Status:

Mother's Name:

Mother's Cell:

Mother's Work Phone:

Father's Name:

Father's Cell:

Father's Work Phone:

Grade in September 2007:


** currently registered families may now proceed to the bottom of the application.

SECTION II New applicants only
How did you hear about our school?
Why have you choosen this school?
What church do you attend on a regular basis?
Last School Attended:

School Address:

School Phone:

Last Grade Attended:

Grade Level Desired:

Has Your Child Repeated A Grade?:

Discipline Problems At School?:


SECTION III New high school students only Gr. 7 - 12 (Parents and Student must complete this portion)
Do you have a police record?:


Why have you choosen this school?
Have you ever used tabacco, alcohol, or illegal narcotics?:


Do you habitually dance or listen to rock music?:


SECTION IV Student Pledge (Gr. 7 - 12 only)
I have read the student handbook and understand what is expected of me as a student at K.B.C.A. I realize that attendance is a privilege and promise to cooperate with my teachers and those in authority to make this year the best school year yet.

Signature of student
Date
** by typing your name above you are implying that you agree to the above terms.

SECTION V Parents Signature
I have read the student handbook and am familiar with the aims and standards of the school and promise my cooperation with enforcement of the rules and regulations. I also agree to pay all tuition and fees when due.

Signature of Parents
Date
** by typing your name above you are implying that you agree to the above terms.