Student Information First Name Middle Name Last Name Date of Birth Date of Birth: Year Year19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Date of Birth: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Date of Birth: Day Day12345678910111213141516171819202122232425262728293031 Age Ethnicity Gender Contact Information Name Relationship Address Address Address 2 City/Town State/Province - Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone 1 Phone 2 Email Secondary Contact Name Relationship Address Address Address 2 City/Town State/Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone 1 Phone 2 Email Emergency Contact Name Relationship Address Address Address 2 City/Town State/Province - None -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone 1 Phone 2 Email Name and Grade of Siblings Attending Inualthuyak School Sachs Harbour Sibling(s) Name Sibling Type Brother Sister Grade - None -KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7 Grade 8Grade 9Grade 10Grade 11 Grade 12 Add another sibling Previous School Year Name of School Grade - None -KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7 Grade 8Grade 9Grade 10Grade 11 Grade 12 Community Phone Medical Information Health Card # Medical Conditions Allergies Supporting Documents Please upload an image/scan of the students health card and birth certificate. Select File(s) Upload I give permission to the Beaufort Delta Education Council to take photographs, video, audio of my son/daughter during their participation of school activities, events or classes and use reproductions or displays of their work. These may be used in school/BDEC newsletters, brochures, marketing, publications and websites. Yes No Submit