REG STRATION—WAYOATA ELEMENTARY SCHOOL - Retsd.mb.ca

______________________________________Province:________________________________________ _______________________________________________________________________Language______________________Ext.:_____________________________________Email:________________REG STRATION—WAYOATA ELEMENTARY SCHOOLKindergarten to Grade 4Student Registration Package605 Wayoata St., Winnipeg, Man., R2C 1J8, Tel: 204.958.6840, Fax: 204.222.5053, www.way.retsd.mb.caThis personal information is being collected under the authority of the Public Schools Act and will be used foreducational purposes. it is protected by the Protection of Privacy provisions of The Freedom of Information andProtection of Privacy Act. If you have any questions about the collection, contact the superintendent of River EastTranscona School DIvision, 589 Roch St., Winnipeg, Man., R2K 2P7, Tel: 204.667.7130Student InformationPlease printSchool year: 20...__J20Usual last name: Usual first name: Usual middle name:___________________Legal last name: Legal first name: Legal middle name:____________________Male U Female UGrade level: __Birth date: (mm/dd/yy)spoken at home:Home address: Apt. # House # Street:City:Postal code:__________________________Box #/Group #/RR #: Student home #: Student cell #:_____________________Are you a resident of River East Transcona School Division? Yes U No U (If no, complete and attach a Schools of Choice application)is the student a high school graduate? Yes U No U Last school attended:If not a Canadian citizen, please identify the CIC (Citizenship and Immigration Canada) authority:a) Permanent resident U b) Refugee claimant U c) Work permit U d) Study permit U e) Other UDate entered Canada: (mm/dd/yy)OFFICE: a—c are provincially-funded studentsContact InformationCustody: Are there any legal restrictions to this student? Yes U No U (If yes, a copy of legal documents must be on file at the school)List in order of priority to call:Primary contact1. LAST name: FIRST name:___________________ Mr.L1 Mrs.U Ms.U Relationship:Address: Same as above U Other:____________________________________________________ Postal code:Employer:Work phone:Home phone:Unlisted? Yes U No U Cellphone:Legal guardian? YesU NoUCan pick up student? Yes U No UHas custody of student? Yes U No UContact by paper? YesU NoUContact electronically? Yes U No USend additional report card? Yes U No UThis contact is restricted? Yes U No UPhone number to call in case of emergency:Student Manitoba Medical:Personal # (9-digit) I I I I I I I I I I Student family # (6-digit) I I I I I IPage 1 of 4 I Tyler SIS 12/2012 * River East TrariscoriaSCHOOL C lvi S ION

hashastrachealoral/nasalREG ISTRATIO N—WAYOATA ELEMENTARY SCH001Medical QuestionnairePlease complete the following (Specify yes if physician-diagnosed)1. Anaphylaxis Yes LI No LI2. Anaphylaxis —EpiPen prescribed Yes LI No LI3. Asthma YesLI NoD4. Asthma —inhaler prescribed Yes LI No LI5. Bleeding(i.e. hemophilia, Von Willebrand disease)YesONoD6. Cardiac condition Yes LI No C7. Catheterization Yes LI No LI8. Central line Yes El No 09. Diabetes Yes LI No LI10. Gastrostomy Yes LI No LI11. Intermittent catheterization Yes LI No LI12. Medication Yes LI No LI13. Nasogastric tube Yes LI No LI14.Osteogenesisimperfecta YesLI NoD15. Ostomy Yes LI No LI16. Other intervention Yes LI No LI17. Oxygen YesO NoD18. Seizure disorder Yes LI No LI19. Steroid dependence Yes LI No LI20. Suctioning (A) —21. Suctioning (B) —suctioning Yes LI No 0suctioning Yes LI No LI22. Tracheostomy Yes LI No LI23. Ventilator Yes LI No 0This medical information is being collected so that appropriate health-care plans may be developed and may benecessary to obtain funding. This information will only be shared with appropriate individuals. This information isprotected by The Personal Health Information Act. Questions should be directed to the school principal.Page 3 of 4 I Tyler SIS 12/2012,:--RiverEastTransconaSCHOOL V VISION

REGISTRATION—WAYOATA ELEMENTARY SCHOOLPlease indicate if the student has utilized any of the following servicesQFFICE if any items have been checked off,forward to the school principal.El ResourceEl ReadingEl PsychiatryEl Social workEl PhysiotherapyEl Child in careEl School counsellor[I PsychologyEl Speech & languageEl Occupational therapyEl Outside agencyEl OtherIf any services above are checked (V), please complete details below.Name of agency/support service:_Address:______________________Contact person:Phone:Briefly describe the reason for service:•Name of agency/support service:Address:Contact person:__________________________Phone:____________________________Briefly describe the reason for service:__________________________________________________________________________The support services information is being collected so appropriate educational services may be provided for yourson/daughter. This information will only be shared with appropriate individuals. This information is protected by TheFreedom of Information and Protection of Privacy Act. Questions should be directed to the school principal.Page 4 of 4 Tyler SIS 12/2012River East Transcona

Wayoata Elementary School605 Wayoata Street,Winnipeg, Manitoba, CanadaR2C 1J8Phone: (204) 958-6840Email:way@retsd.mb.caPrincipal: Mrs. K. CressallWeb Site: http://www.way.retsd.mb.ca Fax: (204) 222-5053Dear Parent/Guardian,PARENTAL INFORMED CONSENT FOROUT OF SCHOOL ACTIVITIES IN THE LOCAL COMMUNITY201 3-2014The purpose of this letter is to inform you about some of the out-of-school activities or events in thelocal school community in which your child will participate during the course of this year. Yoursignature at the bottom of this form confirms that you are aware of the information provided in thisletter.The River East Transcona School Division and the staff of Wayoata School recognize that valuable andunique learning can take place outside of the school building. We are therefore encouraged to makeuse of the total resources of the local community to meet curriculum goals.During the course of the school year, student groups will engage in activities within the localcommunity that may take them out of the school building. These activities may include, but are notlimited to, visiting local destinations such as the museum, fire station, libraiy, Park Manor PersonalCare Home; walking to neighbouring schools to attend musical, theatre or sporting events or topractice school evacuation procedures; walking to local stores or a park; participating in physicaleducation activities or events such as Teriy Fox Walk, community cleanup, walkathon etc.The risk of injury exists in all student activity. However, due to the very nature of some activities, therisk of injury may increase. The safety and well being of students is a prime concern and every effort ismade to minimize the foreseeable risks inherent in any activity.While participating in school activities, which take them into the community, it is expected that studentswill conduct themselves appropriately during all aspects of schooling.If, for some reason, your child cannot or ought not participate in activities of this nature, please let usknow.PARENTAL INFORMED CONSENTIn signing this form Iacknowledge receipt of this letter and the information provided therein.Student’s Name (please pnnt):Parent/Guardian SignatureDate:

_________________________________________________________________________________________________EducationAboriginal Identity Declaration2013-2014 EIS Data CollectionAboriginal Identity Declaration is intended to establish statistical data that will support efforts of ManitobaEducation and school divisions to plan and improve programs in a way that is responsive to Aboriginallearners.LILILI(name of parent/guardian, please print clearly):Am submitting my child’s Aboriginal Identity Declaration for the first time.Am making changes to my child’s Aboriginal Identity Declaration.Already submitted my child’s Aboriginal Identity Declaration and have no further changesto make at this time.My child is Aboriginal (please select only one of the following):LI First NationLI MétisLI InuitUncertain of ancestryLIPlease select, if applicable, up to two of the following languages spoken:LI Anishinaabe (Ojibway/Saulteaux)LI Ininew I Ininiw (Cree)LI Dene (Sayisi)LI DakotaLI Oji-CreeLI MichifLI lnuktitutOther (please indicate if not on the list above)LIProviding this personal information is voluntary and optional. It is being collected in compliancewith section 36(1)(b) of The Freedom of Information and Protection of Privacy Act as it isnecessary for and relates directly to the activity of Manitoba to plan and improve programs andthe activity of the School Division to deliver programs in manner stated above.For more information about Aboriginal Identity Declaration, please contact:Aboriginal Education DirectorateMurdo Scribe Centre510 Selkirk AvenueTelephone: 204-945-7886Toll Free: 1-800-282-8069 ext. 7886Fax: 204-948-2010Email: aedinfogov.mb.caOr visit the website at: http://www.edu.gov.mb.ca/aed/abidentity.htmlStudent Name (please print)Parent/Guardian SignaturePLEASE COMPLETE AND RETURN THIS FORM TO YOUR CHILD’S SCHOOL OFFICE.

ComputerIJND-E1‘RiverEastTranscoria 589 ROCH STREET, WINNIPEG, MANITOBA R2K 2P7S C H 0 0 L 0 V 5 0 N P 204.667.7130 F soo.661.5618 www.retsd.mb.caComputer Use Permission FormFor Students in Kindergarten to Grade 12We are pleased to offer students of River East Transcona School Division access to thedivisional computer network for electronic mail and Internet. To gain access to email andInternet, all students under the age of 18 must obtain parental permission and must signand return this form to the school. Students 18 years and over may sign their own forms.(1) Internet SafeguardsAccess to email and the Internet will enable students to explore thousands oflibraries, databases and bulletin boards while communicating with Internet usersthroughout the world.On a global network, it is impossible to restrict access to controversial materials. Itis the shared responsibility of the student, parent, teacher and administrator toensure that access to networks and computers provided by the school system is notabused.Some material accessible via the Internet might contain items that are illegal,defamatory, inaccurate or potentially offensive to some people. The River EastTranscona School Division uses an Internet filtering system to minimizeaccess to inappropriate websites (e.g: pornography). In addition, all studentemail messages are sent through a content filter, which scans for obscene orthreatening language. While we do everything we can to prevent such access, it isnot possible to guarantee that students will not accidentally or purposely findinappropriate material. We believe that the benefits to students from access to theInternet, in the form of information resources and opportunities for collaboration,exceed any disadvantages. But ultimately, parents and guardians of minors areresponsible for setting and conveying the standards that their children should followwhen using media and information sources. To that end, River East TransconaSchool Division supports and respects each family’s decision whether or not toapprove computer access.(2) Division Internet and Email RulesStudents are responsible for good behaviour on school computer networks just asthey are in a classroom or a school hallway. Communications on the network areoften public in nature. General school rules for behaviour and communicationsapply.The network is provided for students to conduct research and communicate withothers. Access to network services is given to students who agree to act in aconsiderate and responsible manner. Parent permission is required. Access is aprivilege — not a right. Access entails responsibility.Individual users of the divisional computer networks are responsible for theirbehaviour and communications over those networks. It is presumed that users willcomply with divisional standards and will honour the agreements they have signed.Exhibit IJND-E1 —Use Form Kindergarten to Grade 12 Page 1 of 3

Network storage areas may be treated like school lockers. Network administratorsmay review files and communications to maintain system integrity and ensure thatusers are using the system responsibly. Users should not expect that files stored ondivisional servers or workstations would always be private. As outlined in boardpolicy, the following are not permitted:(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)sending or displaying offensive material;sending or displaying violent or pornographic material;using obscene language;using information and communication technology to harass, insult or attackothers (cyber-bullying);damaging computers, computer systems or computer networks;accessing, uploading, downloading or distributing material that the school hasdetermined objectionable;violating copyright laws;using another’s password;trespassing in another’s folders, work or files;intentionally wasting any resources or introducing a virus or any destructivedata into the network;employing the network for commercial purposes.Violations of this policy may result in a loss of access, other disciplinary measures,legal action or a demand for financial reimbursement.A copy of the complete policy (IJND — Computer Technology Use) is available at theschool upon request or at www.retsd.mb.ca.Exhibit IJND-E1 — Computer Use Permission Form Kindergarten to Grade 12 Page 2 of 3

Computer______________Computer Use PermissionParent Permission SectionAs a parent or legal guardian of the minor student signing below, I give permission for myson/daughter to have access to:World Wide Web (Ritered Internet Access)Yes 0 No 0Individual email(Filtered access and for students in grades 3 to 12 only)Yes 0 No 0Please note:Parents who indicate “no” on any of the above points need to discuss this decision withtheir son/daughter.Parental Responsibility:I understand that any violation of use policies could result in loss of access, personalpayment of costs incurred and possible prosecution.Please Initial:I understand that the use of the Internet as part of an educational program is a privilege,not a right, and inappropriate use will result in cancellations of those privileges.Please Initial:Student NameParent NameParent Signature or StudentSignature if 18 years of ageor older.DateSchool Name Homeroom Teacher/Advisor GradeStudent Responsibility and Commitment (Students in Grades 3 to 12, please sign.)As a user of the River East Transcona School Division computer network, I hereby agree to comply with thedivisional computer technology use policy, communicating over the network in a responsible fashion whilehonouring all relevant laws and restrictions.Student NameStudent SignatureThis form will be applicable until the student enters Grade 3, transfers to anotherschool, or parents indicate a change in permissions.Effective Date: June 1, 2004 PolicyAmended Date:June 20, 2006; June 17, 2008RegulationBoard Motion(s) 372/04 326/04 221/08 70/11 Exhibit XXXLegal/Cross Reference:Exhibit IJND-E1 —Use Permission Form Kindergarten to Grade 12 Page 3 of 3

MediaKDDB-E1589 ROCH STREET. WINNIPEG, MANITOBA R2K 2P7C H 0 0 1 0 V S I 0 N P 204.667,7130 F 204,661,5618 www.r4t.cd.rnb.coParent Permission FormMedia Coverage, Copyright PermissionFrom time to time during the school year, the media and/or River East Transcona SchoolDivision may be covering school or divisional events, On occasion, while covering theseevents, students are interviewed and/or still or moving images of them are taken for use bythe media or River East Transcona School Division, for example for use in divisionalpublications or videos, on websites (division, school, teacher websites) or on River EastTranscona School Division’s Facebook page and/or Twitter site.Student Identification on WebsitesPlease be assured that on River East Transcona School Division websites (division,school, teacher websites, Division’s Facebook page and/or Twitter site), your child inkindergarten to Grade 8, and their work will be identified by first name only. It is theschool division’s practice not to include the name of a student in kindergarten to Grade8 with their image on River East Transcona School Division websites.Your child in Grade 9 to 12 and their work may be identified by their full name, and theirfull name may be included with their image, on River East Transcona School Divisionwebsites (division, school, teacher websites, Division’s Facebook page and/or Twittersite). For example, students on a sports team, in the cast of a drama or a musicalensemble, on a student council or committee, may be identified by their full name, withor without their image.Student Copyright PermissionA student’s work is copyrighted to that student. Permission must be granted by thestudent, and their parent/guardian if they are a minor, to have their work published bythe media or River East Transcona School Division, for example in divisionalpublications or videos, or on websites (division, school, teacher websites, Division’sFacebook page and/or Twitter site).Exhibit KDDB-E1 —Coverage, Copyright Permission FormPage 1 of 2

KDDB-E1Please check the appropriate box and sign below:I give permission for my child to be:Interviewed for publication by:School and divisional staff or students (fundraising,newsletters, websites) Yes 0 No 0Media (newspaper, radio, TV) Yes 0 No 0Photographed or to appear on video for publication by:School and divisional staff or students (fundraising,newsletters, websites) Yes 0 No 0Media (newspaper, radio, TV) Yes 0 No 0River East Transcona School Division’s Facebook pageand/or Twitter site Yes 0 No. 0Copyright:I give permission for my child’s work to be published by themedia or the division. Yes 0 No 0Please note:Parents who indicate “no” on any of the permission items identified in the exhibit need todiscuss this decision with their son/daughter, and indicate to the child what actions must betaken in these situations.Student NameParent Name Parent Signature or Student DateSignature if 18 years of age orolderSchool Name Homeroom Teacher/Advisor GradeThis form will be applicable until the student transfers to another school or parentsindicate a change in the permissions.Effective Date: June 1, 2004 PolicyAmended Date:June 17, 2008;December 16, 2008;March 15, 2011; January 17,RegulationBoard Motion(s):2012373/04; 221/08; 392/08; 70/11;9/12:::b1tLegal/Cross Reference:XXXExhibit KDDB-E1 —Media Coverage, Copyright Permission FormPage 2 of 2

Wayoata Elementary School605 Wayoata Street,Winnipeg, Manitoba, CanadaR2C 1J8Phone: (204) 958-6840email:way@retsd.mb.caPrincipal: Mrs. K. CressallWeb Site: http://www.way.retsd.mb.ca Fax: (204) 222-5053PHYSICAL EDUCATION I HEALTH EDUCATIONParental Option for Potentially Sensitive ContentKindergarten to Grade 4 StudentsThe K-4 Physical Education/Health Curriculum contains potentially sensitive outcomes in thefollowing areas:• Personal Safety• Substance Use and Abuse Prevention• Human Sexuality.The curriculum is developmentally and age appropriate. For example, at K-4, Personal Safety helpschildren identify safety rules for child protection and how to avoid dangerous situations. SubstanceUse and Abuse Prevention focuses on identifying helpful and harmful substances and how to safelyand properly take prescription medications. Human Sexuality identifies basic changes in growth anddevelopment such as changes to teeth, height, and clothes size.The Manitoba Education, Citizenship and Youth department of the provincial government hasmandated all potentially sensitive outcomes. Parents have the option to choose school baseddelivery or an alternative delivery for this potentially sensitive content. Alternative delivery of thepotentially sensitive content becomes the responsibility of the parent (i.e., home, professionalcounseling) where the content is in conflict with family, religious or cultural values.Please complete the form attached form indicating either school based delivery or alternatedelivery of the potentially sensitive content for your child. Please note that the permission form is amulti-year form, covering Kindergarten to Grade 4. Choice of school based delivery or alternatedelivery can be changed at any time. Please notify the school, in writing, to request a change.If you require more information, Parent Handbooks and curriculum materials are available at theschool.

Wayoata Elementary School605 Wayoata Street,Winnipeg, Manitoba, CanadaR2C 1J8Phone: (204) 958-6840email: way@retsd.mb.caPrincipal: Mrs. K. CressallWeb Site: http://www.way.retsd.mb.ca Fax: (204) 222-5053PHYSICAL EDUCATION I HEALTH EDUCATIONParental Option for Potentially Sensitive ContentKindergarten to Grade 4 StudentsThe Manitoba Education, Citizenship and Youth department of the provincial government hasmandated all potentially sensitive outcomes.Please complete either the School Based Delivery Form OR the Alternate Delivery Form below:1. School Based Delivery FormMy childChild’s first and last nameGradehas my/our permission to participate in the school based delivery of the potentially sensitive issuesas outlined by the Manitoba Education, Citizenship and Youth curriculum.Parent/ Guardian SignatureDateor2. Alternate Delivery FormI assume the responsibility for an alternative, home based delivery (home, professional counselling)of the potentially sensitive content for my child where the content is in conflict with family, religious orcultural values.Child’s first and last nameGradeParent / Guardian SignatureDateThis page must be signed and returned in its entirety —please DO NOT CUT the bottom portion away from the top portion.