Parent/ Guardian Signature Date

Date: __________________ Port Hardy Secondary Grade: ________

Registration Form

The information on this form is collected under the authority of the School Act. Information is used for Ministry of

Education reporting: demographic, enrollment, budget, facility, transportation and operational analyses. It will be kept

secure and confidential, in accordance with the Freedom of Information and Protection of Privacy Act.

1. Student Demographics

Legal First Name: _____________________ Birthday (dd/mm/yy): ______________________________

Legal Last Name: _____________________ Gender: � Male � Female

Legal Middle Name: _____________________ Siblings who currently attend: _______________________

Usual Name if different: ___________________ Previous School Attended: __________________________

Home Phone Number: ____________________ Country of Birth: _________________________________

Street Address: _____________________________________________________________________________

Mailing Address if different: ___________________________________________________________________

Student Lives With? _____________________ Legal Custody of Student? __________________________

Aboriginal Ancestry? (Y/N): _____ �Non-Status �Status-on-reserve �Status-off-reserve

Band of Origin: _____________________ Band of Residence: ________________________________

2. Health Information

BC Care Card #____________________________

Allergies and Health Conditions:________________________________________________________________

Life Threatening? (Y/N) ______ Comments:_____________________________________________________

Any Other Alerts To Be Made Aware Of? ________________________________________________________

3. Legal Information

Is there a court order? (Y/N) ______ If yes, please specify: ____________________________________

__________________________________________________________________________________________

“I certify that the information I have provided on this form is correct.”

____________________________________ ____________________________

For Office Use Only

Date of request for records made: _________________ Date Records Received: _____________________

�White File Received �PSR Received �Red File Received (if applicable)

4. Contact Information

Name: __________________________________ Relationship to Student: __________________________

Contact Type: �Parent/Guardian �Emergency �Other (specify): _________________________________

Hm Phone #: _____________________________ Wk Phone # __________________________ Ext. _______

Cell Phone # _____________________________ Email: _________________________________________

Address if different: ________________________________________________________________________

� Contact receives correspondence � Contact may not pick up student

Name: _______________________________ Relationship to Student: ____________________________

Contact Type: �Parent/Guardian �Emergency �Other (specify): _________________________________

Hm Phone #: __________________________ Wk Phone # ____________________________ Ext. _______

Cell Phone # __________________________ Email: ___________________________________________

Address if different: ________________________________________________________________________

� Contact receives correspondence � Contact may not pick up student

Name: _______________________________ Relationship to Student: ____________________________

Contact Type: �Parent/Guardian �Emergency �Other (specify): _________________________________

Hm Phone #: __________________________ Wk Phone # ____________________________ Ext. _______

Cell Phone # __________________________ Email: ___________________________________________

Address if different: ________________________________________________________________________

� Contact receives correspondence � Contact may not pick up student

Name: _______________________________ Relationship to Student: ____________________________

Contact Type: �Parent/Guardian �Emergency �Other (specify): _________________________________

Hm Phone #: __________________________ Wk Phone # ____________________________ Ext. _______

Cell Phone # __________________________ Email: ___________________________________________

Address if different: ________________________________________________________________________

� Contact receives correspondence � Contact may not pick up student

Comments: _______________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Port Hardy Secondary School

Parental Consent – Freedom of Information and Protection of Privacy Act

In accordance with the Freedom of Information and Protection of Privacy Act and the School Act.

School District #85 requires consent to use personal information for purpose unrelated to educational programs.

1. Publication of Name, Photograph, Video Images or Comments

At times, staff, district staff, and the media may photograph or videotape individual students and groups of students to

commemorate events and promote various educational, sports and cultural events taking place in the District. While

photographs add to the community life of our school, they are not required for educational purposes. As such, consent for the

release of your child’s name, photograph and comments is required before anything may be published in the yearbook or

newsletter, and on occasion, in the school calendar, school district newsletter, annual report, or in the news media.

Yes: I give my consent for publication of my child’s photograph/video-images, and comments for purposes

consistent with the above.

No: I do not permit the publication of my child’s name, photograph/video-images, and comments for purposes

consistent with the above.

2. School District Website There may be occasions where your child’s photograph may appear as part of a group in a school activity that is placed on the

school district website.

Yes: I give my consent for the publication of my child’s photograph/video-images for purposes consistent

with the above.

No: I do not permit the publication of my child’s photograph/video-images for purposes consistent with the above.

3. School Related Activities - Access to Information

There are occasions when our school would like to have contact with parents to consult with them directly about school issues

or meetings or to plan school related activities. To contact you for these purposes, we then need consent for the disclosure of

your name, home address, email address and phone number to Parent Advisory Councils or others responsible for these types of

activities. Your personal information will not be disclosed to anyone for business or commercial purposes.

Yes: I give my consent for the release of my home address and phone number for purposes consistent with the above.

No: I do not permit the release of my home address and phone number for purposes consistent with the above.

4. Student Access to Technology

School District #85 has provided staff and student access to the Internet. Parents and guardians of minors are responsible for

setting and conveying the standards that their children should follow when using the Internet, Policy 2/20. The role of the

school’s teaching staff includes guiding students’ access to network learning resources and monitoring student use of the

network to ensure students are following acceptable guidelines. It is expected that the Internet will be used to support and

enrich the curriculum.

Yes: I give my consent for my child to have access to the network.

No: I do no permit my child to have access to the network.

5. Parent Consent to Release Name and Phone Number to the Port Hardy Public Health Unit.

This information would be release to the Public Health Unit when information is needed by the Public Health Nurse. (i.e.

student in grade 9 getting their immunization shots by the Public Health Unit administered at PHSS).

Yes: I give my consent for my child’s name and address to be released to the Public Health Unit.

No: I do not give permission to release any information on my child to the Public Health Unit.

Student’s Name

Parental/Guardian Signature__________________________________Date:___________________

� This information will stay effect in the students file until I give written permission to change it.

Freedom of information.doc – September 2012

PORT HARDY SECONDARY SCHOOL P.O. Box 27, Port Hardy, B.C. V0N 2P0

Telephone (250) 949-7443 ● Facsimile (250) 949-2671

Dear Parent/Guardian,

An important part of some of the work at PHSS will involve using Internet-based tools to create and share our learning -- to continue building a lifelong digital portfolio. Research shows the learning that can occur through connection to online resources is critical in the 21st Century. The need to be able to use, critique and adjust to digital information is key to taking part in the world today, as discussed in the BC Ed Plan. With this in mind though, the safety of our students needs to remain our number one concern.

Many digital tools may require your child to create a personal account, using an email account. Please note that your child will use Internet-based tools for both classroom activities and homework assignments, and will continue to hold accounts after coursework is completed.

Your written consent to your child’s use of Internet-based tools is required by the British Columbia’s Freedom of Information and Protection of Privacy Act (FIPPA).

If you choose not to provide your consent to your child’s use of Internet-based tools, your child will not be penalized in any way and alternate activities will be provided, as appropriate.

It is important to be aware that the majority of Internet-based tools below are online services hosted outside of British Columbia and possibly Canada. While stored outside the country, information in your child’s accounts may be subject to the laws of foreign jurisdictions, including, in the United States, the USA Patriot Act.

As a general safe practice, when interacting with any online service, students should take care and avoid posting any personal information or a personal location that could be used to identify themselves or other persons. We recommend not using a full name and last name with identifying birth date and town. Therefore, a student could use initials, or a combination of numbers and letters. Also, using a different year of birth would be more effective for maintaining privacy when signing up for various accounts. For example, a sign-in name could look like bwilliams85 or sjohnsonph.

Some of the programs students may use to explain, document, communicate and store assignments may include: Yearbook, Prezi, Kidblog, Edublog, Voicethread, Wordpress, Twitter, Skype, Wikispaces, Dropbox, Youtube, Evernote, or Google Drive.

Kindly return a copy of this letter to your teacher signed and dated. If you have any concerns, please feel free to contact your son or daughter’s teacher (using the tools) at 250-949-7443.

Consent: I understand that the information my child may create and store could be stored in or accessed from a location outside of Canada, and I hereby consent, on behalf of me and my child, to my child’s information identified above being stored in, or accessed from, a location outside of Canada. This permission to use the tools above is granted for the duration of my child’s time in the Vancouver Island North School District. _______________________________ ______________________________ Signature of Parent or Guardian Signature of Student (if over 13) _______________________________ ______________________________ Print Name Print Student Name and Grade _______________________________ ______________________________ Date Date Port Hardy Secondary School ______ Print School Name Things for students to consider when they are using digital educational technologies: Access to these tools is for educational purposes while completing assignments and collaborating with peers. It is important to establish the norms for responsible and effective communication online. Respectful interactions are important when students are working collaboratively. Select words carefully; think of ways messages will be interpreted; and make important decisions about appropriate ways to respond to others. A good motto to live by while interacting online is:

T - Is it TRUE? H - Is it HELPFUL? I - Is it IMPORTANT? N - Is it NECESSARY? K - Is it KIND? Postings within class sites are subject to the same Code of Conduct that is posted at the school. Students are prohibited to: A. Send, use or display offensive messages, pictures, profanity or inappropriate language B. Harass, insult, or attack others C Access another user’s network account D. Reveal your or anyone else’s private information, such as passwords

E. Post pictures of other students without their permission

PORT HARDY SECONDARY SCHOOL

SCHOOL SPONSORED TRIP CONSENT FORM

1. Throughout the school year, there will be occasions when students will have the opportunity to

participate in local, school related activities off of school property. These trips can help provide

enriched learning activities for students and allow for strengthened community connections. Trips

may include, but are not limited to: hiking on local trails in PE, visiting Eagle View Elementary, local

businesses, the Quatse hatchery and Fort Rupert Big House, walking to the swimming pool and arena.

We would like to have your permission to allow your child to participate in these local activities

throughout the school year.

2. Your child will be accompanied by school staff, but will not necessarily be supervised by an adult at

all times.

3. For trips that take more than one class period or require a bus ride within the school catchment area

(eg. Fort Rupert Big House) an information letter will be sent home with students prior to the trip

taking place.

4. For trips beyond the catchment area, or that are perceived to have any increased risk factors, students

will be given a separate field trip permission form for you to sign and return.

5. If at any time you do not wish to have your child accompany his or her class on an outing off the

school property, please contact the school principal who will arrange an alternate educational

program. If there are any questions or concerns regarding these types of school outings please inform

the school as soon as possible. You can either send this form back with your concerns or you can

phone the school at 250-949-7443.

6. The school district does not provide any accidental death, disability, dismemberment or medical

expenses insurance on behalf of students.

I give permission for __

to participate in school sponsored trips in the local catchment area of Port Hardy Secondary School. I

understand that my child may be exposed to certain risks while participating in activities associated with

local trips off school property. Accidents and injuries may occur.

Signature of Parent/Guardian: ____________________________________________________________

Printed Name of Parent/Guardian: ________________________________________________________

Contact information of Parent/Guardian: ___________________________________________________

___________________________________________________________________________________