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KINDERGARTEN PROFILE

K2023 - Children born in 2018

K2024 - Children born in 2019

Child's first name: *

Child's last name: *

Gender: *

Male:

Female:

Month Applied For: *

Year Applied For: *

Birth Date: Please attach a copy of the birth certificate * +

Parent/Guardian First Name(s) *

Parent/Guardian Last Name(s) *

Main Phone Number *

Main Email Address *

What is the citizenship of your child? *

Student is of indigenous ancestry *

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

Younger Siblings:

Child's Name and Birth Date:

Has your child attended a daycare and/or preschool program? *

No

Yes: please provide details. Yes: please provide details.

I/we give permission for Langley Christian School to contact my child's previous and/or current school for further information if needed: *

No

Yes: Please provide name and phone number below Yes: Please provide name and phone number below

What are your child's strengths/interests? *

What are your child's stretches/needs? *

How do you hope that LCS will partner with you to support your child? *

Is there anything other information you would like to provide about your child or history? *

Does your child have any difficulty with social adjustments? *

No

Yes: please explain. Yes: please explain.

MEDICAL INFORMATION

Are your child's immunizations up to date? *

Yes

No

Care Card Number *

Family Doctor Name: *

Family Doctor Phone: *

Please describe your child's physical condition: *

Can your child participate in a full Physical Education Program? (Note: Physician's note required to miss PE) *

Yes

No: Please describe reason: No: Please describe reason:

Does your child have any of the following medical conditions: All relevant reports must be attached below. *

Please upload relevant reports:

Are any of the above conditions life threatening? *

No

Yes: If yes, please explain: Yes: If yes, please explain:

Does your child take medications? (If yes, Medical Consent Waivers are available at main office) *

No

Yes: If yes, please explain: Yes: If yes, please explain:

Does your child require assistance in taking medications? (If yes, Medical Consent Waivers are available at main office) *

No

Yes

Additional comments:

EDUCATIONAL SUPPORT SERVICES

Is English your child's first language? *

Yes

No: If no, what is first language? No: If no, what is first language?

Is your child's current/prior schooling in any language other than English? *

No

Yes: If yes, what language? Yes: If yes, what language?

Is there a possibility that your child will require English Language Learning instruction? *

No

Yes

Does your child have any difficulty with speech or language? *

No

Yes

Has your child received, or is your child receiving, Speech Language Therapy? Please attach copy of Speech Language Report. *

No

Yes

If you selected "yes" to the previous question...

Speech Articulation only

Language Development / Social Skills

Please upload relevant reports:

Has your child received, or is your child receiving, Occupational Therapy? *

No

Yes

Please upload relevant reports:

Has your child received services through a Child Development Center? *

No

Yes

Please upload relevant reports:

Does your child experience anxiety or behaviour issues? If yes, please briefly describe below the nature of the anxiety or behviour issues and strategies used. *

No

Yes Yes

Does your child have any of the following: Autism, FASD, Cerebral Palsy, Prenatal Exposures?

No

Yes

Is your child awaiting any testing or assessments?

No

Yes

Please upload relevant reports:

CHILD CUSTODY

Has there been Social Services involvement regarding your child? *

No

Yes: please explain further Yes: please explain further

Please upload relevant documents:

Are there court orders regarding custody of your child? *

No

Yes: please explain further and provide copies of relevant documentation. Yes: please explain further and provide copies of relevant documentation.

Please upload relevant documents:

Person(s) to contact in case of emergency other than parent/guardian and has permission to pick up the child: *

Relationship to child: *

Phone: *

Person(s) to contact in case of emergency other than parent/guardian:

Relationship to child:

Phone:

SIGNATURE

Available spaces are filled according to our acceptance policy preferences and then to the date the completed application has been received by the LCS Central Office. For families new to LCS, acceptance will be confirmed after an admissions interview. *

I/we understand

Signed by parent/guardian *

clear

Type your name: *

Attach a copy of the birth certificate: *

If applicable, attach a copies of any additional documentation/diagnosis/reports:

If applicable, attach a copy of any court orders regarding custody:

None	Diabetes
Asthma	Epilepsy
Hearing Problems	Vision Problems
Allergies: See Anaphylaxis Policy on website.	Heart Conditions
Pre-mature birth: # of weeks? Pre-mature birth: # of weeks?