Breadcrumb Home StrongStart Registration Indicates required field Child Info Legal First Name Legal Last Name Legal Middle Name(s) Usual First Name Usual Last Name Usual Middle Name(s) Birthdate Gender at Birth Female Male Gender Identity Female Male Non-binary Proof of Age Original Birth Certificate Passport Landed Immigrant Auth INAC Status Card Proof of Age document image One file only.5 MB limit.Allowed types: gif, jpg, jpeg, png, webp, pdf. Custody (select one) Both Parents Mother Father Other, specify Enter other… Court Order (select one) No Yes, describe Enter court order details… Home Address Address Postal Code Languages spoken at home Which program will you attend most often? - None -Brent Kennedy ElementaryBlewett ElementaryCanyon Lister ElementaryCrawford Bay SchoolCreston Ed CenterHume ElementaryJewett ElementaryJVHumphries SchoolRedfish ElementaryRosemont ElementarySouth NelsonW.E.Graham SchoolWinlaw Elementary Will you attend any other programs? Choose all that apply Brent Kennedy Elementary Blewett Elementary Canyon Lister Elementary Crawford Bay School Creston Ed Center Hume Elementary Jewett Elementary JVHumphries School Redfish Elementary Rosemont Elementary South Nelson WE Graham Winlaw Elementary Parent/Guardian Info Parent/Guardian Parent/Guardian First Name Last Name Parent/Guardian Type Mother Father Other… Enter other… Phone Email Street Address City Province Postal Code Emergency Contact Emergency Contact Emergency Contact First Name Last Name Relationship to Child Home Phone Work Phone Cell Phone Can this contact pick up the Child? Yes No Health Conditions Life Threatening Condition Yes No Yes, Anaphylactic Anaphylactic details Yes, Asthma that has resulted in hospitalization in the past year Asthma details Yes, Blood Clotting Disorder Blood Clotting Disorder details Yes, Diabetes Diabetes details Yes, Epilepsy with a history of Tonic-Clonic (Grand Mal) seizures in the past two years Epilepsy details Yes, Serious Heart Condition (e.g. heart murmur, heart repair) Serious Heart Condition details Yes, Other Health Conditions which may require emergency care - please specify Other Health Conditions details Non-Life Threatening Condition Non Life Threatening Health Condition (food allergies/sensitivities): Please describe Declaration: By submitting this information for StrongStart registration, I also certify that the information I have provided on this form is correct.