Mother Earth's Children's CharterSchool

Student Registration Form

1. Student Information

Student Legal Last Name:______

Student’s First and Middle Name:______

Date of Birth:______

Grade:______Sex: ___Male ___Female

Home telephone:______Email:______

Cellular Number:______

Student’s preferred names: (if different than legal names)

Student’s preferred last name:______

Student’s preferred first name:______

Student’s current residential address:______

Street/Country address:______

Town/ City:______Province:______

Postal Code:______Subdivision:______

LegalLand Description: ______

¼ Sec TWP Rge W of Block Lot

2. Student’s Permanent Mailing Address (if different than residential address)

Apt # or Suite _____ Street Address or rural address______


Do you need information about the MECCS bussing program?______

3. Emergency Information

Alberta Health Care # ______

Student’s Doctor’s Name:______Telephone:______

Emergency ContactName#1:______Relationship:______

Telephone # of Contact Name #1:______Cell:______

Emergency Contact Name #2:______Relationship:______

Telephone # of Contact Name #2______Cell:______

4. Medical and Family Information

Does your child have any serious medical conditions about you wish the school to be aware? ____Yes ______No Please specify:______


Emergency action required for the above:______

Please note any family circumstances that you wish the school to be aware:_____



Name of babysitter/daycare:______Telephone #______

Parent, Legal Guardian or assumed guardian information:

If there are tow parents or legal guardians, it is important to fill in both sections, whether or not the parents or legal guardians are living together: (A “legal guardian” is a person appointed by the court as the guardian. Documentation is required. An “assumed guardian” is someone who is caring for the students with the consent of the student’s parent (s) or guardian(s), but has not been made a legal guardian. An assumed Guardian should not sign this form).

Student lives with:___ Both Parents ___ Legal Guardian

___ Father Only___ Assumed Guardian

___Mother Only___ Foster Home

____ Other (Please specify)______

Mother (Guardian):______

Father (Guardian):______

5. Treaty Information (if applicable)

If you wish to declare that you are an Aboriginal person, please specify by circling:
Status Indian/First Nations / Non-Status Indian/First Nations / Métis / Inuit
Alberta Education is collecting this personal information pursuant to section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act as the information relates directly to and is necessary to meet Ministry and School Board mandates and responsibilities to measure system effectiveness over time and develop policies, programs and services to improve Aboriginal learner success. This information will also be used to determine the provincial First Nations, Métis and Inuit Funding Allocation provided to school jurisdictions.
For further information or if you have questions regarding the collection activity, please contact the office of the Director, Aboriginal Policy, Policy Sector, Strategic Services Division, Alberta Education, 10155-102 Street, Edmonton AB, T5J 4L5, (780) 427-8501

Do you have treaty status? _____ Yes ______No

Do you reside on a reserve? ______Yes ______No

On which reserve do you live?______

Band #______Family#______Child Pos. #______

6. Custody

In some instances a child may be designated as “Protected” if a court has issued a restraining order under the Child Welfare Act, the Domestic Relations Act, the Divorce Act, or the Young Offenders Act. Please indicate if the school administration should be aware of any such Court Order, for the protection of your child. ______Yes ______No

If “yes”, you must provide legal documentation to support your request.

7. School History

Name of previous school attended______

Name of previous school district ______

Please list siblings

Name / Age / Grade / Gender

8. Charter Specific Information

Please let us know any pertinent information about your child’s likes or dislikes:


I would like my child to learn to speak (please check in front of choice(s):

____Cree____Stoney____Extra Support in English

____Sign Language

I am willing to commit to participating in the school community in the following ways:




I am committed to support my child in his/her education by:______




I,______, the parent of______

understand that I am an important and valued part of the Mother Earth's Children's CharterSchool community. As such I herby commit to:

  • Expressing my/our ideas, suggestions and concerns in an open and respectful way within the school community,
  • Supporting my/our children in their education in the best way that I/we can,
  • Participating in the planning of my children’s educational program,
  • Participating in the school community programs to the best of my ability,
  • Ensuring that my child maintains a minimum attendance rate of 80%.

I herby agree to and accept these responsibilities.I also understand that M.E.C.C.S. is an Indigenous education program. I make the commitment, along with my child(ren), that my child(ren) will fully participate in all classes and program components. This includes smudge and prayer, Indigenous studies, second language classes, arts, physical wellness and all special events.

Parent Name: ______Signature:______

8b. Cultural Land-based Activities

I allow my child to attend cultural land-based activities on the MECCS land at AlbertaBeach. I also allow my child to go to Alexander, Paul Band, Alexis, and Enoch for cultural activities, as long as I am made aware ahead of time. I understand that the children will be bussed to and from the site.

Parent Signature:______Date:______

9. Photo Release

Our school is the first IndigenousCharterSchool in Canada. We have many photo opportunities at MECCS, and would like you to fill out the following statement.

I allow my child to be photographed for the following: Please check all that apply to you:


School Bulletin Boards

Internet picture galleries

Special Interest stories in local newspapers and magazines.

Parent Signature:______Date:______

10. School Fees

Mother Earth’s Children’s CharterSchool does not charge monetary school fees. Instead, we ask each family to gather their “school fees” over the summer and provide the following as their contribution to the school for the year:

One braid of sweet grass per student

One bundle of sage per student

One bag of frozen raspberries per student

One bag of frozen saskatoons per student

One bag of blueberries per student

*** Note: berries may be in quart sealers rather than frozen in bags. These supplies will be used for feasts and ceremonies throughout the school year. They promote whole family involvement and continued learning over the summer.

Section 23 Francophone Education Eligibility Declaration

The personal information collected on this form is collected by the (school board name) pursuant to the provisions of the Student Record Regulation, (A.R. #225/2006), section 10 of the School Act, and section 23 of the Canadian Charter of Rights and Freedoms and may be used to ensure your child has a program that meets his or her needs. Information in Question A is provided to Alberta Learning as required by the Student Record Regulation and will be treated in accordance with Alberta’s Freedom of Information and Protection of Privacy Act andmay be shared with a Francophone Regional authority. Should you have any questions regarding the collection of this information, please contact (position, address, telephone # of person at School Board who can answer questions).

Section 2 (1) of the Student Record Regulation states that:

The student record of a student must contain all information affecting the decisions made about the education of the student that is collected or maintained by a board, regardless of the manner in which it is maintained or stored including…

(s) if the parent of a student is eligible to have the student taught in the French language pursuant to section 23 of the Canadian Charter of Rights and Freedoms, a notation to indicate that and a notation to indicate whether the parent wishes to exercise that right.

Pursuant to Section 23 of the Canadian Charter of Rights and Freedoms:

Citizens of Canada

  • whose first language learned and still understood is French; or
  • who have received their primary school instruction in Canada in French have the right to have their children receive primary and secondary instruction in French; or
  • of whom any child has received or is receiving primary or secondary school instruction in French in Canada,

have the right to have all their children receive primary and secondary school instruction in the same language.

In Alberta, parents can only exercise this right by enrolling their child in a French first language (Francophone) program offered by a Francophone Regional authority.


A.According to the criteria above as set out in the Canadian Charter of Rights and Freedoms, are you eligible to have your child receive a French first language (Francophone) education? (Please place an X in the appropriate box.)

Yes NoDo not know

B.If yes, do you wish to exercise your right to have your child receive a French first language (Francophone) education?

Yes No

MECCS Student Registration Form Updated October 15/07 V: Registration Forms

Rediscovering the gifts and potential of our children through traditional Indigenous teachings and respect.