Name * First Name Last Name Email Address * Phone Number * Home Address * Applying for: * Grade 10 Grade 11 Grade 12 Post-Graduate Last team played for: Position * Height * Weight * Date of birth * Citizenship * Mother/Legal Guardian * Include First name, Last name, address if different from students, telephone number, and email Father/Legal Guardian * Include First name, Last name, address if different from students, telephone number, and email Emergency Contact * Include First name, Last name, address if different from students, telephone number, and email Does your child have any allergies? Yes No Does your child take any medications? * Yes No ESL Support A student may be eligible for ESL support when the primary language spoken at home is not English . Is the primary language spoken at home English Yes No Where did you learn about Saskatoon Basketball Academy? * Parent Questionnaire Has your child received any modified programming or had the assistance of an Educational Assistant for any reason? * Yes No Has discipline ever been an issue at home, in school, or in sport? * Yes No Has your child ever been expelled, dismissed, suspended, or placed on probation by any school or athletic organization? * Yes No Why are you considering a change in your child's school? * Has your child ever had a psycho-educational assessment? * Yes No Has your child ever been under the care of a counselor, psychiatrist, or psychologist? * Yes No Please add any additional information you feel is important for SBA to know. How many schools has your child attended since Kindergarten? * Current Academic Average * Please email a copy as soon as possible to t.saskatoonbasketballacademy@gmail.com c/o Tanner Kozun, Academic Adviser. Personal Information Consent * I consent to having Saskatoon Basketball Academy collect personal information that may include student identification information, birth certificate, legal guardianship, court orders if applicable, parents’ work numbers and email address, behavioral, academic and health information, most recent report card, emergency contact names and numbers, health insurance number and any similar information needed for registration. I further consent to the use and disclosure of information contained in this form and otherwise collected by or on behalf of Saskatoon Basketball Academy for the following purposes: • for the evaluation, admission and registration of new students • for the re-registration of returning students • for determining eligibility for provincial grants • for the confidential use of the school’s health care professionals and counselor for the purpose of providing health services • for accounting and billing purposes • for school advancement, development and fundraising • for parent ambassadors’ purposes • for school communications, publications, notices and marketing materials • photographs and work samples of students may be used in school communications, publications, notices and promotional materials This information is required in order to register your child at the school, to provide services to parents, students, and staff, and to assist the school authority in making an informed decision as to your child’s suitability and appropriate placement in the school. It will also allow the school to respond immediately to an emergency. If you do not want your personal information used for any of the above purposes, or for more information, please contact our Academic Adviser, Tanner Kozun, who may be reached at (306)768-8776. I agree Thank you!