Application Form

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When do you desire entrance to HCA?

Do you have student(s) that currently attend HCA?

YesNo

What are their names and grades?

Application Checklist - CURRENT FAMILIES

Please make sure to have the necessary documents prepared before submitting your application. The application cannot be submitted without the following:

Report Cards - Your child's most recent report card ( Current Academic Year) and final report card for the last academic year (not applicable for Kindergarten or Early Learning)
Identification Document - Examples include Birth Certificate, Permanent Resident Card, Passport, or Visa
Educational Testing (if applicable) - Individualized Program Plan (IPP), psycho-educational assessments, etc.

Application Checklist - NEW FAMILIES

Please make sure to have the necessary documents prepared before submitting your application. The application cannot be submitted without the following:

Report Cards - Your child's most recent report card and final report card for the last school year (not applicable for Kindergarten or Early Learning)
Identification Document - Examples include Birth Certificate, Permanent Resident Card, Passport, or Visa
Educational Testing (if applicable) - Individualized Program Plan (IPP), psycho-educational assessments, etc.
Pastoral Reference - You will need an email address for your Pastor.
Payment Details - Have a valid payment method (bank information or credit card) ready to cover the application fee of $150.

By applying to Heritage Christian Academy (HCA) I/we understand that HCA is jointly operated by the Heritage Christian Education Society Calgary (HCESC) and Palliser School Division. I/we acknowledge that I/we have read and understood the HCESC PIPA (Personal Information Protection Act) Policy and consent to the collection, use, and disclosure of my/our personal information by HCESC in accordance with this policy, including the sharing of information with the Palliser School Division.

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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:

Child Lives With

Grade Applying For:

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 of the year they are applyling for kindergarten.

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:

I agree that failure to disclose information may result in deregistering the student from HCA

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.

Birth Certificates

Your child's most recent report card (current academic year) and final report card for the last academic year (not applicable for Kindergarten)

Copy of Citizenship documents (example: PR card, Visa) - if applicable

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

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:

Custody Documents - only if applicable

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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)
Child

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Application Fee

Please note: The application fee is non-refundable

Application Fee

Promo Code Discount

Total Amount

How would you like to pay?

Credit CardBank Account

Payment Information

Name on Account

Bank Name

Transit Number

Bank Number

Account Number

Bank Account Number

Prefix

Account Type

CheckingSavings

Payment Information

Name on Card

Card Number

VISA OR MASTERCARD ONLY

MM

YY

Code

Billing Email

Billing Address

First Name

Last Name

Street

City

Province

Postal Code

Application Fee

Since you are an existing family, no application fee is required!

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