HCA Application Form

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Are you applying for the 2023-2024 school year?

YesNo

When do you desire entrance to HCA?

Have any of your children applied for HCA in the past?

YesNo

Do you have children that currently attend HCA?

YesNo

Application Checklist - CURRENT FAMILIES

Please note: Your application will not be considered until all of the following have been submitted:

Report Cards - Most recent copy and final copy for most recently completed grade (Not applicable for Kindergarten)
Canadian Citizenship - Birth Certificate, PR Card, Passport, Visa, etc.
Educational Testing - IPP, psycho-educational assessments etc. - only if applicable
You DO NOT have to pay the $250 Application Fee if you already have other students attending HCA.

** You can upload these documents at the end of the application, drop them at the school office or email them to enrolment@hcacalgary.com

Application Checklist - NEW FAMILIES

Please note: Your application will not be considered until all of the following have been submitted:

Report Cards - Most recent copy and final copy for most recently completed grade (Not applicable for Kindergarten)
Canadian Citizenship - Birth Certificate, PR Card, Passport, Visa, etc.
Educational Testing - IPP, psycho-educational assessments etc. - only if applicable
$250 Application Fee (non-refundable) - payable on HCA website
Pastoral Reference (may be submitted directly from church) - Form is on HCA website

** You can upload these documents at the end of the application, drop them at the school office or email them to enrolment@hcacalgary.com

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If you are applying for more than 1 student, remember to click the "ADD ANOTHER STUDENT" link at the bottom right of this page.

STUDENT INFORMATION

Student Details

Legal First Name:

Legal Middle Name:

Legal Last Name:

Preferred Name if different from above:

Languages spoken at home

Birthdate (MM/DD/YYYY):

Gender:

MaleFemale

Current Grade:

Grade Applying For:

Are you applying for Out of School Care?

Kindergarten Detail

Please indicate your day of preference

Monday, Wednesday and alternating Friday's Tuesday, Thursday, and alternating Friday'sNo Preference

I understand that my day preference choice is not guaranteed and will be confirmed in June with my Kindergarten information package.

I understand that my child must be 5 years old by December 31, 2022 to be eligible for Kindergarten starting September 2022.

Standard Detail

Alberta Student Number (if known):

Last grade completed:

Last school attended:

Location (City/Town, Province):

Out of School Care

Please indicate the type of care you are interested in:

For Drop In Care or Custom Schedule, please describe the details and include how much time in advance you would be able to request these days or provide a schedule. (ie. specific days of the week, 1-2 weeks per month, everyday but only 30 min - 1 hour, etc.)

Medical Information

Alberta Health Care Number:

	Yes	No
My child is NOT up to date with immunizations (please list missing immunizations below)
My child has health concerns (ie. asthma, epilepsy, hearing, vision, etc.)
My child receives medication on an ongoing basis
My child has developmental concerns (ie. behaviour, mobility, speech/language, etc.)
My child has specialists involved in their development
My child has special dietary or food concerns that the program should be aware of

If you answered YES to any of the questions above, please explain or provide details:

Child's allergies if known (reaction symptoms):

Special instructions in case of allergic reaction:

If school staff will be required to administer medication, please request the appropriate form from the school office.

First Nations Self-Identification

If you wish to declare the student is Aboriginal, please select one:

First Nations (Status)First Nations (Non-Status)MetisInuit

For further information, please refer to: https://education.alberta.ca/system-supports/results-reporting/everyone/results-reporting/

or contact Alberta Education at 780-427-8501.

If you have questions regarding the collection of student information by the school board, please contact the Palliser Regional Schools Superintendent at 403-328-4111.

Francophone Eligibility

Does your child have Francophone Eligibility?

YesNo

The exercise of Francophone eligibility rights refers to instruction in a Francophone school, NOT a French Immersion school. According to the School Act and Section 23 of the Canadian Charter of Rights and Freedoms, a student is eligible for instruction in a Francophone school if at least one parent is a Canadian citizen and one of the following three conditions exists:

- Either parent's first language learned and still understood is French, or

- Either parent has received their primary school instruction in Canada, in French, or

- One or more of the parent's children has received or is receiving primary or secondary instruction in French in Canada

In Alberta, parents can only exercise this right by enrolling their child in a French first language (Francophone) program, offered by a Francophone Regional authority. Heritage Christian Academy does not have a Francophone program. Contact Palliser Regional Schools for a listing of Francophone authorities.

Student History

Due to current funding levels as provided by Alberta Education, there may be limited resources to accommodate additional needs. Each case will be evaluated based on the specific needs of the student.

Please complete the following section as thoroughly as possible. The information you provide will enable us to better accommodate and assist your child.

	Yes	No
Has your child ever repeated a grade?
Has your child had any discipline issues at school or a suspension?
Has your child ever been asked to leave or withdraw from a school?

If Yes, Please Explain:

Educational Accommodations

Has your child been recommended for or received help for any special learning needs? (ie. Learning Disability, Hyperactivity, ADD, Remedial/resource instruction, or other)

Yes - Please include any relevant documents with your application.No

How was the need for support determined?

Please explain the diagnosis and learning needs:

Has your child ever been on an Individual Program Plan (IPP) in school or received additional assistance from a Learning Support Assistant/Teacher?

Yes - Please include a copy of program plan or any relevant documents with your application.No

Grade:

Code level and types of support received:

Does your child have any physical handicaps/limitations that may affect his/her participation in physical activity?

YesNo

If Yes, Please Explain:

Has your child ever accessed any of the following services?

	Yes	No
Speech/Language Therapy or Assessment
Auditory Assessment
Occupational Therapy (fine motor skills)
Behavior Support
Physio Therapy
Psycho Educational Assessment
Psychological Counselling
Extra Tutoring from a private facility

IF YES, please include reports with this application.

Do you have another student to add? If yes, please click the link............................

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FAMILY INFORMATION

Parent Contact Information

Name:

Relationship to Student:

Email

Name:

Relationship to Student:

Email

NEW FAMILY INFORMATION

Please provide any custody documentation to show who is the legal decision maker for the child(ren).

If school staff are required to enforce a custody or restraining order, a copy MUST be submitted to the school.

Parent/Guardian 1

Salutation

First Name:

Last Name:

Relationship to student:

Home Phone

Mobile Phone

Work Phone

Preferred Phone

Email Address:

Lives with Student:

Street Address / Box Number:

City/Town:

Province:

Postal Code:

Parent/Guardian 2

Salutation

First Name:

Last Name:

Relationship to student:

Home Phone

Mobile Phone

Work Phone

Preferred Phone

Email Address:

Lives with Student:

If address for Contact 2 is different, please enter it below:

Street Address / Box Number:

City/Town:

Province:

Postal Code:

Emergency Contact 1

First Name:

Last Name:

Address:

Home Phone

Mobile Phone

Work Phone

Relationship to Student:

Emergency Contact 2

First Name:

Last Name:

Address:

Home Phone

Mobile Phone

Work Phone

Relationship to Student:

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NOTICE OF RELIGIOUS INSTRUCTION

Pursuant to section 11.1(2) of the Alberta Human Rights Act, we are required to inform you that students attending this alternative school within Palliser Regional Schools will receive religious (Bible based, Christian education) instruction, exercises and instructional materials. Religion (Bible based and Christian world view teaching) permeates the school program. The Palliser Board of Trustees supports faith-based alternative programs within Palliser Regional Schools. Should you have questions, please contact Heritage Christian Academy.

Household Information

Please list any additional children in your family that you have not included in this application and are not applying to HCA at this time:

	First Name	Last Name	Date of Birth (MM/DD/YY)
1
2
3
4
5
6

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UPLOAD DOCUMENTS

Application Checklist - CURRENT FAMILIES

Please note: Your application will not be considered until all of the following have been submitted:

Report Cards - Most recent copy and final copy for most recently completed grade (Not applicable for Kindergarten)
Canadian Citizenship - Birth Certificate, PR Card, Passport, Visa, etc.
Educational Testing - IPP, psycho-educational assessments etc. - only if applicable
You DO NOT have to pay the $250 Application Fee if you already have other students attending HCA.

** You can upload these documents at the end of the application, drop them at the school office or email them to enrolment@hcacalgary.com

Application Checklist - NEW FAMILIES

Please note: Your application will not be considered until all of the following have been submitted:

Report Cards - Most recent copy and final copy for most recently completed grade (Not applicable for Kindergarten)
Canadian Citizenship - Birth Certificate, PR Card, Passport, Visa, etc.
Educational Testing - IPP, psycho-educational assessments etc. - only if applicable
$250 Application Fee (non-refundable) - payable on HCA website
Pastoral Reference (may be submitted directly from church) - Form is on HCA website

** You can upload these documents at the end of the application, drop them at the school office or email them to enrolment@hcacalgary.com

Birth Certificates

Your child's most recent report card and final report card for the last school year (not applicable for Kindergarten or Early Learning)

Copies of any educational testing (IPP, psycho-educational assessment etc.) - if applicable

Pastoral Reference Form

Custody Documents - only if applicable

Personal evaluation	Registered Psychologist	General Practitioner
Teacher/Learning Support Teacher	Other

Shine FM	City Light News	Road Signs	Community Newsletters
Drive By	Social Media	Online Search	Referred by Friend
Other