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Student Profile | Grade 1 - 12
Child's first name:
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Child's last name:
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Gender:
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Male
Female
Grade application:
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1
2
3
4
5
6
7
8
9
10
11
12
Month Applied For:
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September
October
November
December
January
February
March
April
May
June
Year Applied For:
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2023
Birth Date: Please attach a copy of the birth certificate (at end of document)
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+
Parent/Guardian First Name(s)
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Parent/Guardian Last Name(s)
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Main Parent Contact Email
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Last school attended:
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Grades attended:
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Previous school attended: (if applicable)
Grades attended:
I/we give permission for Langley Christian School to contact my child's previous and/or current school for further information if needed:
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Yes
No
What are your child's strengths/gifts?
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What are your child's stretches/needs?
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How do you hope that LCS will partner with you to support your child?
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Is there any other information you would like to provide about your child or their history?
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What is the citizenship of your child?
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Student is of indigenous ancestry
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No
Yes. If yes please provide Band of Origin, Band of Residence and Status Card Number (if applicable). This information is voluntary to provide
Yes. If yes please provide Band of Origin, Band of Residence and Status Card Number (if applicable). This information is voluntary to provide
Does your child have, or has your child experienced, any social issues at school?
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No
Yes. If yes please explain
Yes. If yes please explain
Has your child every been involved in disciplinary action by a school?
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No
Yes. If yes please explain
Yes. If yes please explain
To help Student Services prepare for course planning for your child, please indicate
ALL the courses
that they are registered in for this school year and what date they will be completed by. (Grade 9-12 Students Only)
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Has your child taken the provincial Literacy Assessment? (Grade 10-12 Only)
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No
Yes. If yes please explain
Yes. If yes please explain
Has your child taken the provincial Numeracy Assessment? (Grade 10-12 Only)
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No
Yes. If yes please explain
Yes. If yes please explain
Medical Information
Care Card Number
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Family Doctor Name:
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Family Doctor Phone:
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Please describe your child's physical condition:
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Can your child participate in a full Physical Education Program? (Note: Physician's note required to miss PE)
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Yes
No
Does your child have any of the following medical conditions:
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None
Diabetes
Asthma
Epilepsy
Hearing Problems
Vision Problems
Allergies (Please see Anaphylaxis Policy on website)
Heart Conditions
Contact Lenses
Premature Birth: # of weeks premature:
Premature Birth: # of weeks premature:
Are any of the above conditions life threatening?
No
Yes: please explain:
Yes: please explain:
Does your child require assistance in taking medications? (If yes, authorization forms are available at main office)
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No
Yes: please explain:
Yes: please explain:
English Language Learning (ELL)
Is English your child's first language?
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Yes
No: what is first language?
No: what is first language?
Is your child's current/prior schooling in any language other than English?
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No
Yes: what language?
Yes: what language?
Is your child or has your child received ELL support in the last three years? Or have they been recommend to receive ELL support over the last three year?
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Yes
No
Educational Support Services
Has your child been diagnosed with anxiety? Are there any social or emotional concerns?
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No
Yes: When:
Yes: When:
Please attached reports below:
Has there ever been behavioural concerns?, or is there currently a behaviour and/or safety plan in place for your child?
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No
Yes: Please explain:
Yes: Please explain:
Please attached reports below:
Has your child been diagnosed with ADHD?
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No
Yes: When:
Yes: When:
Please attached reports below:
Has your child received, or is your child receiving, Speech Language Therapy?
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No
Yes: When:
Yes: When:
Please attached reports below:
Does your child have any academic concerns ( Literacy or Math)
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No
Yes: Please Explain
Yes: Please Explain
Has your child had, or is your child currently being tutored outside of school?
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No
Yes: When and subjects:
Yes: When and subjects:
Has your child repeated any grades?
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No
Yes: which grades and what year:
Yes: which grades and what year:
Is your child scheduled to receive any diagnostic assessments or testing or have they been recommended by the school for an assessment?
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No
Yes: Please explain and when will these tests take place?
Yes: Please explain and when will these tests take place?
Has your child ever received, or is your child receiving, any of the following support services.
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Psych Ed Assessment
Learning Assistance
Special Education
Enrichment / Gifted
English Language Learning
None of the above
Is your child scheduled to receive any diagnostic assessments or testing or have they been recommended by the school for an assessment?
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No
Yes: Please explain and when will these tests take place?
Yes: Please explain and when will these tests take place?
In the event of an immediate need arising in school, I acknowledge that my child may receive support from the Social Emotional Learning Team (Youth Care Worker, School Counsellor).
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Yes
No
No
Please attach reports below:
Child Custody
Has there been Social Services involvement regarding your child?
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No
Yes: please explain further
Yes: please explain further
Please attach documents below:
Are there court orders regarding custody of your child?
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No
Yes: please explain further and provide copies of relevant documentation.
Yes: please explain further and provide copies of relevant documentation.
Please attach documents below:
Emergency Contact
Person(s) to contact in case of emergency other than parent/guardian (contact has permission to pick up child):
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Relationship to child:
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Phone:
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Person(s) to contact in case of emergency other than parent/guardian (contact has permission to pick up child):
Relationship to child:
Phone:
Signed by parent/guardian
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clear
Type your name:
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Attach a copy of the birth certificate:
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Middle and High school Students -
Attach a copies of your child's lastest report card from this year and June's final report card from the previous year.
Grade K-5 - Attach a copies of your child's lastest report card from this year and June's final report card from the previous grade. (if applicable)
If applicable, attach a copy of the most recent IEP. LSP or SLP:
If applicable, attach a copy of any court orders regarding custody:
Any other relevant documents: