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Hitherfield School

Elementary Application

Step 1 of 2

50%

Application for Admission
Student Information
Student Name
Surname Given Names
Sex
- Male
- Female
Date of Birth (mm/dd/yyyy)
Date Format: MM slash DD slash YYYY
Number of days to be enrolled (full days)
Health Card OHIP#
Height
Weight
Hair Colour
Eye Colour
Physical Marks
Present Academic Grade
Last School Name
Last School Address
Family Information
Parent/Guardian #1 Information
Parent/Guardian 1 Name
First Last
Relationship to child
Home Address
Street Address City Postal Code
Occupation or Title
Employer
Business Address
Telephone
Business no
Cell no
Fax no
Email
Parent/Guardian #2 Information
Parent/Guardian 2 Name
First Last
Relationship to child
Home Address
Same as parent #1

Street Address City Postal Code
Occupation or Title
Employer
Business Address
Telephone
Business no
Cell no
Fax no
Email
Child lives with:
Both Parents
Mother
Father
Guardian
Emergency Contact
EC #1 Name
Phone Number
Relation
EC #2 Name
Phone Number
Relation
STUDENT PROFILE
Has the student ever been identified as in need of special education?
Yes
No
If so, please provide identification dates and particulars, continuing on the reverse, if necessary.
Does the student have any allergies, physical limitations, or other medical conditions?
Yes
No
If so, please provide identification dates and particulars, continuing on the reverse, if necessary.
Is the student receiving any prescribed medication(s)?
Yes
No
If so, please provide the name of the medication, and both the dosage amount and frequency.
What are your family’s three (3) most important educational expectations of Hitherfield School?
1. 2. 3.
APPLICATION PROCESS

1) Please attach copies of this and last year’s academic reports (if applicable), and of the student’s immunization records.

2) Upon receipt of the preceding Application Form, a school visit and student interview will be arranged with you. (There is no fee for this process.)

3) If, after that school visit and student interview, you wish to proceed with student admission, then the following Registration Agreement, together with the non-refundable tuition deposit of $1500.00 should be submitted.

4) Upon receipt of the Registration Agreement and the non-refundable tuition deposit of $1500.00, a letter confirming acceptance of student admission will be mailed out to you.

5) Students will only be accepted mid-semester if such acceptance is academically, emotionally, and socially in the student’s best interests. Tuition fees for part of any current academic year consist of the full non-refundable tuition deposit of $1500.00, together with monthly tuition payments for each whole or part (prorated) month during which the student is in attendance.
1) Please attach copies of this and last year’s academic reports (if applicable), and of the student’s immunization records. 2) Upon receipt of the preceding Application Form, a school visit and student interview will be arranged with you. (There is no fee for this process.) 3) If, after that school visit and student interview, you wish to proceed with student admission, then the following Registration Agreement, together with the non-refundable tuition deposit of $1500.00 should be submitted. 4) Upon receipt of the Registration Agreement and the non-refundable tuition deposit of $1500.00, a letter confirming acceptance of student admission will be mailed out to you. 5) Students will only be accepted mid-semester if such acceptance is academically, emotionally, and socially in the student’s best interests. Tuition fees for part of any current academic year consist of the full non-refundable tuition deposit of $1500.00, together with monthly tuition payments for each whole or part (prorated) month during which the student is in attendance.

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REGISTRATION AGREEMENT: JK - Grade 8

Hitherfield School accommodates children who thrive on a challenging academic program, who benefit from small class sizes and the opportunity to move ahead at their own level, who enjoy outdoor activities and forest/pond exploration, who are respectful of themselves and others, and whose parents are willing and ready to support Hitherfield School’s policies, philosophy, and activities for the benefit of all. By signing this Registration Agreement, we represent as parent(s) that both our child, as a student, and I or we as parent(s) meet all of these above accommodations and commitments to support.

In consideration of the accepted enrollment of the above-mentioned child into Hitherfield School as a student, I/we agree to pay all student tuition fees and any other indebtedness incurred by the student, or on the student’s behalf.
Hitherfield School accommodates children who thrive on a challenging academic program, who benefit from small class sizes and the opportunity to move ahead at their own level, who enjoy outdoor activities and forest/pond exploration, who are respectful of themselves and others, and whose parents are willing and ready to support Hitherfield School’s policies, philosophy, and activities for the benefit of all. By signing this Registration Agreement, we represent as parent(s) that both our child, as a student, and I or we as parent(s) meet all of these above accommodations and commitments to support. In consideration of the accepted enrollment of the above-mentioned child into Hitherfield School as a student, I/we agree to pay all student tuition fees and any other indebtedness incurred by the student, or on the student’s behalf.
I/We agree to pay the student tuition fees for the 2020-2021 school year as follows: (Select one)
Lower School - Junior Kindergarten to Grade 3 - $15,600.00
Middle School - Grade 4, 5, 6 - $15,600.00
Upper School - Grade 7, 8 - $15,600.00
I authorize HITHERFIELD SCHOOL to charge the following credit card for payments as required.
Payment Arrangement: (Select one)
monthly
bi monthly
in full
Name on Card
Card type
Account
Expiry date
Please check the box beside the statement:
Hitherfield School accommodates children who thrive on a challenging academic program, who benefit from small class sizes and the opportunity to move ahead at their own level, who enjoy outdoor activities and forest/pond exploration, who are respectful of themselves and others, and whose parents are willing and ready to support Hitherfield School’s policies, philosophy, and activities for the benefit of all. By signing this Registration Agreement, we represent as parent(s) that both our child, as a student, and I or we as parent(s) meet all of these above accommodations and commitments to support. In consideration of the accepted enrollment of the above-mentioned child into Hitherfield School as a student, I/we agree to pay all student tuition fees and any other indebtedness incurred by the student, or on the student’s behalf.
Parent/Guardian 1 Signature
Parent/Guardian 2 Signature
Date
Date Format: MM slash DD slash YYYY

Please check the box beside each statement:
I/We understand, for the safety and security of all students and staff, that Hitherfield School and its agents reserve the right at any time or times, with or without notice, to conduct physical searches of the student and his or her personal property, and I/we irrevocably consent to such searches.
I/We understand that there are always risks of student personal injury, death, and damage to personal property, because of the physical activity and sports components of the school programme. I/we acknowledge, accept, and assume these risks, and un- equivocally and expressly consent to the above student’s full participation in all of the above programme components.
During the above student’s enrollment at Hitherfield School, I/we authorize and appoint the School Principal of Hitherfield School and her agents
a) to act as legal guardians of the above student;
(b) to publicize by (electronic or print media) any and all photographs of, or including, the above student taken in the usual or ordinary course of Hitherfield School’s programming;
(c) to deliver to the parent(s) and/or the guardian(s) of the above student all report cards and an Ontario Student Transcript regarding the above student, and
(d) to make all necessary decisions on the above student’s behalf in all of these regards.
This Registration Agreement constitutes the entire agreement between the contracting parties concerning the subject matter here- of. All prior agreements, discussions, representations, warranties and covenants are merged herein. There are no warranties, representations, covenants or agreements, expressed or implied, between the parties except those expressly set forth in this agreement. Any amendments or modifications of this agreement shall be in writing and executed by the contracting parties.
This Registration Agreement constitutes the entire agreement between the contracting parties concerning the subject matter here- of. All prior agreements, discussions, representations, warranties and covenants are merged herein. There are no warranties, representations, covenants or agreements, expressed or implied, between the parties except those expressly set forth in this agreement. Any amendments or modifications of this agreement shall be in writing and executed by the contracting parties.
(Note: ALL custodial parents MUST sign.)
Dated this:
Date Format: MM slash DD slash YYYY

Name #1
First Last
Signature
Name #2
First Last
Signature
Personal information is collected under the authority of the Education Act, and will be used for the establishment (if necessary) and maintenance of the Ontario Student Record in accordance with The Ontario Student Record (OSR) Guideline 2000. Access to the OSR may be obtained by written request directed to the School Principal.
Initials

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Hitherfield School

Step 1 of 2

Application for Admission

Student Information

Family Information

Emergency Contact

STUDENT PROFILE

APPLICATION PROCESS

REGISTRATION AGREEMENT: JK - Grade 8

I authorize HITHERFIELD SCHOOL to charge the following credit card for payments as required.

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