Application Form For Entrance 2023-24 Applicant Information First name Middle name Last name Birth date To enter grade - Select -56789101112 Does the applicant have a serious allergy (i.e. anaphylactic allergies)? Yes No If yes, please describe Current School Information Current school Current school telephone Current school address Student Information 1. Has your child ever been identified as exceptional by a School Identification, Placement, and Review Committee? Yes No If yes, then please attach the most recent Individual Education Plan here One file only.100 MB limit.Allowed types: jpg, jpeg, png, pdf, doc, docx. 2. Has your child ever required any special education program or services, including any modified or alternative learning expectations or accommodations? Yes No 3. Has your child ever been diagnosed by a medical professional (such as a doctor, psychiatrist, or psychologist) as any one or more of: Behavioural; Autistic; Deaf, hard-of-hearing, or other Language impairment; Speech impairment; Learning disability; Giftedness; Mild intellectual, Developmental, or Physical disability; and/or Blind or low vision? Yes No 4. Has your child ever received support from a special education teacher? Yes No 5. Has your child ever been suspended or expelled from a school? Yes No Please note that Leahurst College is relying upon your answers to the above five questions to its detriment, pending the future receipt of your child’s Ontario Student Record and any other student records from outside of Ontario. Should the future receipt of any of these records not confirm the veracity of your answers to the above five questions, then Leahurst College reserves the right to immediately terminate the enrollment of your child, at the sole and exclusive discretion of the Head of School. Citizenship Country of birth If you were born in Canada, please also provide province of birth If you were not born in Canada, please state the date of entry into Canada Legal status in Canada Uniform Order Information Please provide all measurement information in inches Family Information Applicant lives with - None -Both parentsBoth parents, shared timeMother onlyFather onlyGuardian Parent #1 Parent 1 title Parent 1 title - None -Mr.Mrs.Ms.Dr.Other Enter title Parent 1 first name Parent 1 middle name Parent 1 last name Parent 1 address Address City/Town Postal Code Parent 1 home phone Parent 1 cell phone Parent 1 business phone Parent 1 correspondence email Parent 1 business name Parent 1 occupation and position Parent #2 Parent 2 title Parent 2 title - None -Mr.Mrs.Ms.Dr.Other Enter title Parent 2 first name Parent 2 middle name Parent 2 last name Parent 2 address Address City/Town Postal Code Parent 2 home phone Parent 2 cell phone Parent 2 business phone Parent 2 correspondence email Parent 2 business name Parent 2 occupation and position Siblings Sibling name Sibling's current school Sibling name Sibling's current school General Information How did you hear about Leahurst College? Sign-off Compliance with the rules of the school by the parents and student is understood as a condition of the student’s admission. In consideration of Leahurst College admitting and undertaking the education of the above named as a student, the undersigned hereby agrees to pay Leahurst College all fees and charges that shall at any time hereafter become due and payable in respect of such student. The information provided in this application remains the confidential property of Leahurst College. Name of parent 1 (or guardian) Name of parent 2 (or guardian)
