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Applicant Information

Have you e-transferred the $100 application fee to vperalta@kempenfeltbayschool.ca? Please note that we do not action applications until the application fee has been received. ^*

Yes No

Applicant's First Name^*

Applicant's Last Name^*

Applicant's Date of Birth^*

Entry Grade^*

Current School^*

Current Grade^*

Year of Entry^*

Parent Information

Parent/Guardian One - Name^*

Parent/Guardian One - Email^*

Parent/Guardian One - Mobile Phone^*

Parent/Guardian One - Profession/Occupation^*

Parent/Guardian One - Name of Employer^*

Parent/Guardian One - Full Address^*

Postal Code^*

City^*

Parent/Guardian Two - Name^*

Parent/Guardian Two - Email^*

Parent/Guardian Two - Mobile Phone^*

Parent/Guardian Two - Profession/Occupation^*

Parent/Guardian Two - Name of Employer^*

Parent/Guardian Two - Full Address (if different from above)

Family Information

Who should be contacted regarding the application?

Parent/Guardian One Parent/Guardian Two Both

Parental Marital Status^*

Please indicate who has legal custody of the applicant

In the case where separated or divorced parents share joint custody of the applicant, we require contact information for both parents to proceed with an admissions application.

Please select who should receive billings^*

Parent/Guardian One Parent/Guardian Two Both

Applicant Academic & Medical Information

Is the applicant in any of the following streams?^*

French Immersion Gifted Program ESL Other None

Is the applicant in any of the following programs:

Occupational Therapy Speech Therapy IBI/ABA therapy

Does your child have a psychoeducational assessment?^*

If your child has a Psychoeducational Assessment, please attach it here.

Does your child have an Individualized Education Plan (IEP)?^*

If your child has an Individualized Education Plan (IEP), please attach it here.

Has the applicant skipped or repeated a grade?^*

Does the applicant have any allergies?^*

If the applicant has allergies, please list them below and indicate their severity (i.e., anaphylactic, season allergies)

Does the applicant require medication during the school day?^*

If you selected Yes, please indicate the medication the applicant takes.

Why have you applied to join Kempenfelt Bay School?^*

How did you hear about Kempenfelt Bay School?

How did you hear about Kempenfelt Bay School?^*

Friend Current or Past KBS Family Colleague Internet Research Social Media Sibling or Family Member attended KBS School Signage Other

Please attach the applicant's June 2021 report card

Please attach the applicant's June 2022 Report Card

Plesae attach the applicant's most recent report card or academic report

Recent photo^*

Please attach a recent photo of the applicant

Proof of Age^*

Please attach a copy of the applicant's birth certificate or passport

If this application is accepted by Kempenfelt Bay School, I/We hereby agree to be bound by the rules,
regulations, behavioural and financial expectations of Kempenfelt Bay School.

Please accept the terms & conditions to submit this form.

Kempenfelt Bay School - Admissions Application Form

Applicant Information

Parent Information

Family Information

Applicant Academic & Medical Information

How did you hear about Kempenfelt Bay School?

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