Welcome to Khalsa School!

 
Welcome to Khalsa School!
Welcome to Khalsa School!
                              Waheguru Ji Ka Khalsa, Waheguru Ji Ki Fateh!

Khalsa School is a unique Sikh Private Educational Institution with a closed campus policy. We have a drug,
    alcohol and smoke free environment. Khalsa School is a place where students’ lives are enlightened
   with the highest moral and spiritual values. Khalsa School has established very high standards for our
            academic and religious education programs. Students take part in a variety of sports
              tournaments, academically and religiously oriented competitions and scores of
                 other extra-curricular activities. Children also learn the Sikh Way of Life.
                                  We are delighted to educate your child.
                           Visit our website for more information or contact us.
                                                 Thank you!
                                               Administration
                                           Khalsa School Surrey
                             Khalsa School Newton campus Ph.:604-591-2248
                                 Khalsa Primary School Ph.:604-597-6464
                            Khalsa Old Yale Road Campus Ph.: 604-951-2333
                               Khalsa Secondary School Ph.: 604-585-8200
                                       E-mail: info@khalsaschool.ca
                                      Website: www.khalsaschool.ca

                                                      1
2015-2016 Khalsa School Session fees
  1. Tuition fee is to be paid as follows:

       a.   Full year payment: Paying for full year claim 5% discount (if paid by cash or cheque) or 2% discount (if paid
            by Visa /Master card or debit) at the time of Registration.

       b. Payment in 3 installments: If paying for 4 months (September to December) or 5 months for KG of KPS
          (August to December) and 2 instalments of 3 months each (January to March and April to June) by post-
          dated cheques or Pre Authorization of credit card, there is no discount and parents will be required to sign
          an authorization form and a consent form. No payment on monthly basis will be accepted.

            If you want to pay 2nd and 3rd instalments by cash, give us post-dated cheques or pre authorization of credit
            card with dates and if we receive cash before that date, we will not process the cheque or credit card.

       c. Monthly Tuition fees:
              1.   KG of KPS only:             $110
              2.   Grade 1 to 7 (KSN) :        $150
              3.   K.G to Grade 7 (OYR) :      $150
              4.   Grade 8 to 12 ( KSS):       $160

       d. NSF: For NSF cheques or two time credit card payment decline, $20 fees will be charged.

  2. Parents pay the following fees also at the time of registration to Khalsa School:

       a. Registration fees $125.00 (Non Refundable)
       b. Agenda fee $10.00 (Non Refundable)
       c. Year Book $10.00 (Non Refundable) -: Charged for one per family
       d. Text book borrowing fee $50.00 (for Gr.1 to Gr. 12 only – Non Refundable)
       e. Applied Science $25.00 (for Grades 8 to 12 only – Non Refundable)
  3. The Parents have to pay for the whole year regardless of whether they take the child out during the school year.

Note: All Fees (Registration fee, Annual Fees, Tuition Fees, Bus Fee, &
Donations) are Non-Refundable/Non-Transferable.

                                                           2
YEAR 2015-2016 STUDENT FEES
                                                 ANNUAL CHARGES
Agenda:                                       $10.00 (K-10)
Year Book:                                    $10.00 (K-10)
Text Book Borrowing:                          $50.00 (1-10)
Applied Sciences:                             $25.00 (8–10)

Registration Fee: $125 per child
Tuition Fee:                                  GRADE 8 TO 12(Khalsa Sec. School OYR)
                 $160.00 Per month 1st child*10 months Sept/15 to June/16 - $1600.00 after discount $1520.00(cash & cheque only)
                 $160.00 Per month 1st child* 10 months Sept/15 to June/16 - $1600.00 after discount $1568.00(visa & mc only)
                 $140.00 Per month 2nd child* 10 months Sept/15 to June/16 - $1400.00 after discount $1330.00(cash & cheque only)
                 $140.00 Per month 2nd child* 10 months Sept/15to June/16 - $1400.00 after discount $1372.00(visa & mc only)
                 $125.00 Per month 3rd child* 10 months Sept/15 to June/16 - $1250.00 after discount $1187.50(cash & cheque only)
                 $125.00 Per month 3rd child* 10 months Sept/15 to June/16 - $1250.00 after discount $1225.00(visa & mc only)

                                              GRADE 1 TO 7(Khalsa School Newton)
                                              GRADE K TO 7(Khalsa School OYR)
                 $150.00 Per month 1st child*10 months Sept/15 to June/16 - $1500.00 after discount $1425.00(cash & cheque only)
                 $150.00 Per month 1st child* 10 months Sept/15 to June/16 - $1500.00 after discount $1470.00(visa & mc only)
                 $130.00 Per month 2nd child* 10 months Sept/15 to June/16 - $1300.00 after discount $1235.00(cash & cheque only)
                 $130.00 Per month 2nd child* 10 months Sept/15 to June/16 - $1300.00 after discount $1274.00(visa & mc only)
                 $115.00 Per month 3rd child* 10 months Sept/15 to June/16 - $1150.00 after discount $1092.50(cash & cheque only)
                 $115.00 Per month 3rd child* 10 months Sept/15 to June/16 - $1150.00 after discount $1127.00(visa & mc only)

                    * Students must be siblings – proof may be requested

                                   KINDERGARTEN FEES (For Khalsa School Newton Only)
                 110.00 per month 1st child   11 months Aug/15 – June/16 - $1210.00 after discount $1149.50 (cash & cheque only)
                 110.00 per month 1st child   11 months Aug/15 – June/16 - $1210.00 after discount $1185.80(visa & mc only)
                 If 2nd child is in KG $105.00 11 months Aug/15 – June/16 - $1155.00 after discount $1097.25 (cash & cheque only)
                 If 2nd child is in KG $105.00 11 months Aug/15 – June/16 - $1155.00 after discount $1131.90(visa & mc only)
                 If 3rd child is in KG $100.00 11 months Aug/15 – June/16 - $1100.00 after discount $1045.00(cash & cheque only)
                 If 3rd child is in KG $100.00 11 months Aug/15 – June/16 - $1100.00 after discount $1078.00(visa & mc only)
Bus Fee:
                Bus fee two way local (Surrey, Delta): $100.00       Bus fee one way local: $60.00
                Bus fee long distance two way: $125.00               Bus fee long distance one way: $75.00

                                        Please Note: All fees are not refundable

                                                                 3
KHALSA SCHOOL UNIFORM 2015-16

This is a list of uniform items. All items, except socks and shoes, can be purchased from the school. Parents must make sure that the
student has enough uniform sets to be in school uniform whenever he/she is attending this school. Starting this year 2015–16 the new
uniform will be in full effect. Students will not allowed to wear the old uniform.

                                                     KINDERGARTEN TO GRADE 7
                                                      REGULAR UNIFORM: BOYS

    1.       White kurta with white pajama. OR
    2.       Navy Blue polo shirt with the school logo and Grey Pants with the school logo.
    3.       Dark blue head covering – turban or rumal only (Grade 7 boys must wear turbans)
    4.       White socks and black comfortable dress shoes

                                                        REGULAR UNIFORM: GIRLS

    1.   White kameez with blue salwar OR
    2.   Navy Blue polo shirt with a logo and Grey Pants with a logo.
    3.   Dark blue head covering – turban or rumal only
    4.   White socks and black comfortable dress shoes

                                         PHYSICAL EDUCATION (PE) UNIFORM KG TO GRADE 7
                                                             BOYS AND GIRLS
    1.   Dark blue jogging pants with the school logo including dark blue T-shirt with the school logo
    2.   Dark blue head covering (rumal or turban – Grade 7 boys must wear turbans)
    3.   White socks and runners without black soles

                                                          GRADE 8 TO 12
                                                     REGULAR UNIFORMS: BOYS
   1.    White Kurta with white pajama. OR
   2     White polo shirt with the school logo and black pants with the school logo.
   3.    Dark black head covering – turban only
   4.    White socks and black comfortable dress shoes
                                                       REGULAR UNIFORM: GIRLS
    1.   White kameez with black salwar OR
    2.   White polo shirt with the school logo and black pants with the school logo.
    3.   Dark black head covering – rumal or turban
    4.   White socks and black comfortable dress shoes

                                                   PHYSICAL EDUCATION (PE) UNIFORM
                                                     BOYS AND GIRLS GRADE 8 TO 12

    1.   Dark black jogging pants with the school logo including dark black T-shirt with Khalsa School logo.
    2.   Dark black head covering rumal or turban for boys.
    3.   Runners without black soles & white socks only.

    NOTE:
     Not allowed:-- Tearaways, shorts, jeans, flairs, vests, earrings, rings, necklaces, nail polish, make up, baseball caps etc.
              PE strips are for PE classes and lunch time only. However, Grade KG to 3 students are allowed to wear PE strips for full
                day if they have PE classes on that day. All students are allowed to wear their PE strips for field trips if they wish to.
                Students are reminded that dress shirts must be neatly and completely tucked in their waist band. No jackets are to
                be worn in class or in the Gurdwara. Students without proper school uniform will be asked to go home or have their
                uniform delivered to the school. If a student continually forgets their uniform then disciplinary action may be taken.
              The students are responsible for their own clothes and belongings.

                                                                   4
Khalsa School
                                     List of necessary School Supplies for all grades
                                                     Session 2015-16
        #    Supplies                                     KG       1       2       3      4      5     6       7     8 to 12
        1    Scissors 4.5”                                 1       1       1       1
        2    Scissors 6”                                                                 1      1      1       1        1
        3    Wax Crayons (Pack of 24)                      1       1       1       1     1      1      1                1
        4    Pencils with eraser (pack of Ten)             2       2       2       2     2      2      1       1        1
        5    Pencil crayons – set of 24                    1       1       1       1     1      1      1       1        1
        6    Ruler 30cm.                                           1       1       1     1      1      1       1        1
        7    Eraser – White Vinyl                                  2       2       2     2      2      2       2        2
        8    Glue Sticks                                   6       6       6       6     4      4      4       4        4
        9    Pencil Box or Pencil Case                     1       1       1      2      1      1      1       1        1
        10   Paper Clips                                           1       1       1     1      1      1       1        1
        11   Felt Colors (24 Pack)                         1       1       1       1     1      1      1       1        1
        12   Fine Felt Pens (24 Pack)                              1       1       1     1      1      1       1        1
        13   Highlighters                                                                1      1      1       1        1
        14   Pens ( Blue & Red) Gel                                                      6      6      6       6        6
        15   Duo Tangs with pocket folders                         10     10      10     10     10     10      0        10
        16   Report Covers                                                               5      5      5       5        5
        17   Coiled Note Books (lined)                                                   3      6              2        10
        18   Note Books – Interlined 72 Page               4       4       4       6     6
        19   Note Book – Half Interlined 72 Page           1       1       1       2     1
        20   Note Book - Full lines 72 Pages               1       1       1       2     2       6     6       6        6
        21   Pocket Folders                                4       4       4       2     4       4     4       1        4
        22   Graph paper pad (Pack of 100 Sheets)                                        1       1     1       1        1
        23   Loose Leaf papers ( Packs of 200 Sheets)                              2     2       4     4       6        6
        24   Binders 3 ring 1.5”                                           1       1     1       1     1       6        3
        25   Pencil Sharpeners                             1       1       1       1     1       1     1       1        1
        26   Tracing Paper Book                                            1       1     1                     2
        27   Scrap Paper Book 14” x 11”                    1       1       1       1     1       1     1
        28    Scotch Tape                                                  1             1       1     1       1        1
        29   Dictionary                                                            1     1       1     1       1        1
        30   Thesaurus                                                                                         1        1
        31   Scientific Calculator                                                               1     1       1        1
        32   Back Pack                                     1       1       1       1      1      1     1       1        1
        33   Index Dividers                                                                      1     1       1        1
        34   Geometry Set                                                                        1     1       1        1
        35   Cloth bag with drawstring for PE strip                                       1      1     1       1        1
        36   Agenda (from School)                          1       1       1       1      1      1     1       1        1
        37   Small Notebook for Kirtan class                               1       1      1      1     1       1        1
        38   French/English Dictionary                                                           1     1       1

Note:   1. Students are not allowed to use liquid paper for corrections. Do not buy liquid paper.
        2. Text Books will be issued by the school. Students will be required to pay for lost or damaged books. Report cards will not
           be issued until student has paid any fines owing or school fees.
        3. Write your child’s name on the school supplies.

                                                                  5
KHALSA SCHOOL SURREY

         6
NEWTON, OLD YALE ROAD, KHALSA HIGH SCHOOL
                                      E-mail: kssinfo@khalsaschool.ca
                                       Website: www.khalsaschool.ca
PLEASE ADMIT MY CHILD ________________________________TO GRADE ________________________________________
Child’s Family Name _____________________________________________ Male           -   Female (Circle 0ne)
Address______________________________________________________City____________________________________________
Postal Code _______________________                Home Phone No. ______________________________________
Date of Birth (Month)        (Day)      (Year)       Place of Birth ___________________________Citizenship ______________
Child’s Religion ____________________ Amritdhari __Yes / No___Nitnem Daily Yes / No _____________________________
Previous School (Name) _________________________ & City/Prov./Country ____________________________________________
Grade Completed ____________ (Date) ____________
Level of Punjabi: Reading __________________________________ Writing _____________________________________________
Other children in this School:       Name: ________________________________________Grade: ___________________________
                                     Name: ________________________________________Grade: ___________________________
FATHER:
Name        __________________________________ Occupation ______________________Religion          _____________________
Phone (work) _________________________________Cell:_____________________________Email_________________________
MOTHER:
Name        __________________________________ Occupation ______________________Religion          _____________________
Phone (work) ________________________________ Cell:_____________________________Email_________________________
Or Legal Guardian:
Name        __________________________________ Occupation ______________________Religion          _____________________
Phone (work) _______________________________________ Cell:_____________________________________________________
Emergency contact if parents unavailable:    Name __________________________________________________________________
Relation _______________________________ Phone: _______________________________________________________________
Bus Service required? ___________
I AGREE TO ABIDE BY THE SCHOOL PHILOSOPHY AND CODE OF CONDUCT (copy is attached) I understand that
all fees are non-refundable___________________________________       DATE: _________________
Parent/Legal Guardian Signature.
FOR OFFICE USE ONLY:
   1. Birth Certificate: _____
   2. Care Card:_____
   3. Proof of Parent’s Status: _____
   4. Proof of child’s Status: _____
   5. Proof of Residence
   6. Immunization record for KG students only
Verified By: __________________________

Admission Approval: ____________________________                         ________________________
                           (Principal’s Signature)                     Date

                                                              7
Khalsa School, Satnam Education Society

                                          Student Medical Information

Please note that the following information is confidential

Student’s name     __________________                Date of Birth: ______/____/____ Female or Male
Permanent Address: __________________                               YYYY MM DD
                   __________________                Country of Birth: ____________
                   __________________                Citizenship:     _____________

Home Phone Number                       ____________________ Parents Cell Phone Numbers______________

Students email address: _________________________ Parents email address: ______________________

Care Card No.                           _____________________
Physician’s Name                         _____________________
            Address:                    _____________________
                                        _____________________
            Telephone                    _____________________

Emergency Contact Numbers:

 Name                                           Name

 Phone # home: _____________________            Phone # home: _____________________
 Work:___________________                       Work:___________________
 Cell:____________________                      Cell:____________________
 Relationship to student                        Relationship to student

 Address                                        Address

Medical History
Has the student ever experienced any of the following:

[ ] Arthritis        [ ] Sleepwalking [ ] Heart Condition [ ] Diabetes       [ ] Seizure Disorder
[ ] Ear Troubles     [ ] Sinus Troubles [ ] Migraines        [ ] Cancer       [ ] Frequent Colds
[ ] Motion Sickness [ ] Epilepsy        [ ] Hysteria      [ ] Nose Bleeds [ ] Bronchitis
[ ] Tonsillitis       [ ] Nightmares     [ ] Rheumatism       [ ] Fainting    [ ] Asthma
[ ] Kidney Trouble [ ] Convulsions       [ ] Skin diseases [ ] High Blood Pressure [ ] Anemia
[ ] Seasonal Allergies [ ] Nut Allergies [ ] Back or Neck pain [ ] Major Surgeries please specify
[ ] Other? Please give specifics.

                                                          8
Medical History Continued……

Do you have any allergies?

 [ ] Foods           List foods:
                     Type of Reaction:
 [ ] Insects         Type of Insect:
                     Type of Reaction:
 [ ] Drugs           Name:
 [ ] Hay fever       List of Causes:
                     Type of Reaction:
 [ ] Other           Please give specifics

Please explain any specific treatment or drugs for any of the above listed allergies or ailments?
For example, Use of hypo-spray for asthmatic condition or anaphylactic injection for bee stings…..

Check one:
                      Excellent       Good           Poor             Aids if Aids are used which ones:
Eyesight              [ ]             [ ]            [ ]              [ ]   Glasses
Hearing               [ ]             [ ]            [ ]              [ ]   Hearing Aids
                                                                      [ ]   Contact Lenses

                                             Other Medical History

When was the last time the student had a Tetanus inoculation or booster (d/m/y)? ______________

Is the student taking any prescription or non – prescription drugs?            [ ] yes [ ] no
Please Specify.
Name of Drug: _________________________________________________________________
Reason for taking drug: __________________________________________________________

All the information is accurate as of today’s date. If there are any changes, I agree to contact Khalsa School with
the updated information.

Date: ____________________            Signature of Parent or Guardian: _____________________
                                      Printed Name:                  ______________________

                                                           9
Khalsa School, Satnam Education Society

Consent to Medical Treatment

Student’s name     __________________               Date of Birth: ____/____/____ Male or Female
Permanent Address: __________________                              YYY MM DD
                   __________________               Country of Birth: ____________
                   __________________               Citizenship:     _____________

Home Phone Number                      ____________________ Parents Cell #’s

Emergency Contact Name:                _____________________ ______________________
Emergency Contact Number:              _____________________ ______________________

I agree that Khalsa School accepts no liability in connection with the supervision or administrating of
medication to my child. Khalsa School will not supervise the administration of prescribed medication to
students unless the parent or guardian expressly authorizes the administration of medication at school, the
parent or guardian provides explicit written instructions regarding the manner in which the medication is to be
administered, and there is staff available to undertake this task.

   1. I do hereby consent to administrating prescription medication and to emergency medical treatment to
      my son/daughter while he/she is at Khalsa School.
      Student Drug Allergies:    ____________________________________
      Signature Parent/Guardian: __________________________________
      Printed Name:              ___________________________________
      Date:                      ____________________________________

   2. I do not wish my son/daughter to be given any medication while he/she is at Khalsa School.
      Signature Parent/Guardian: ___________________________________
      Printed Name:              ___________________________________
      Date:                      ____________________________________

                                        PHYSICIAN’S STATEMENT
I, ___________________________________________, am a qualified Physician licensed to practice in British
Columbia. I am the attending physician for _____________________________ and hereby approve and
authorize the medication and the administration of such medication referred to above.
DATED at _______________________________, B.C., _________________________ 201__.
                                                           ____________________________
                                                           Physician Signature

                                                            Physician Printed Name &
                                                            Identification number

                                                            ___________________

                                                            ___________________

                                                       10
KHALSA SCHOOL SURREY
                                          NEWTON/OLDYALEROAD
                                             Email: kssinfo@khalsaschool.ca
                                             Website: www.khalsaschool.ca

                                                CODE OF CONDUCT
AS A STUDENT OF KHALSA SCHOOL YOU ARE EXPECTED TO PRACTICE GOOD MANNERS AND
TREAT OTHERS WITH RESPECT AND KINDNESS; TO ACT ACCORDING TO THE PRINCIPLE OF
VIRTUE, EXCELLENCE AND GRACE; TO USE GOOD COMMON SENSE.YOU WILL EXCEL AS AN
INDIVIDUAL AND AS A SIKH.
SHOULD THESE EXPECTATIONS NOT BE MET BY A STUDENT, THERE WILL BE A WARNING,
DETENTION OR PARENT MEETING. IF NECESSARY, A STUDENT WILL BE SUSPENDED FROM
THE SCHOOL, WE HOPE THAT NO STUDENT WILL BE EXPELLED, BUT THIS IS AN OPTION IF,
DESPITE ALL EFFORTS, THE STUDENT’S BEHAVIOUR IS NOT CHANGED.

1.    Unless a student has made arrangements with a teacher, the student should arrive no earlier than 10minutes before the first
      bell. There is no supervision if the child arrives too early at the school in the morning.

2.    Khalsa School has a closed campus policy. This means students must remain on the school grounds from the time they arrive
      until dismissal at the end of the school day. Students must stay at the school for the lunch period. If students leave the
      premises without prior approval, he or she will be suspended.

3.    Students who are late in the morning must report to the office for a late slip.

4.    Visitor/parents who come to Khalsa School must check in at the office upon arrival and have permission to enter the
      premises.

5.    All students, guests and staff are required to wear a head covering at all times, even during physical education activities.

6.    The Gurdwara is a place for reverence and students are expected to show the utmost respect.

7.    Move quietly in hallways, always using the right side, and only use those hallways/stairs assigned to each grade.

8.    All lunches and snacks must be vegetarian (no meat, fish or eggs).

9.    Report to a supervising teacher about any situation, which you consider dangerous to yourself or others.

10.   If you are assigned a locker, you are responsible to take care of it. Lockers will be and can be inspected from time to time by
      administration or teachers.

11.   While travelling in our school buses, students must always remain seated, talk softly, keep their hands inside the bus and
      follow all safety rules. Students may not bring hockey sticks on the bus. Any infraction of these rules will lead to suspension
      of bus service to the student.

12.   Bus students are advised that the buses have set schedules to meet both coming to and leaving school. Therefore, if you are
      late, the bus drivers will be unable to wait for you.

13.   Gum chewing is not permitted on the buses or at School.

14.   Items not allowed at school or in school buses; PSP’s, DVD player, Game Boys, Nintendo DS, I pods, MP3 players, cell
      phones, skateboards, any type of skates, play guns (including water guns), liquid paper, or gum etc. If confiscated, no item
      will be returned.

15.   All bikes must be locked and placed in a bike rack. Bikes are not to be used until school is dismissed.

                                                                 11
16.       Rules regarding school uniform are given below and must be followed, they are as follows:

       The regular school uniform is required while travelling to and from School, throughout the School day and for Field Trips,
        unless otherwise specified in writing from the administration. Shirts must always be completely tucked into your pants.

       The head covering must come across the forehead; no hair is to be showing in the front. If a female is wearing a dupatta, she
        must also wear a rumal.

       Female students must wear their hair in one or two braids only or a Jura on top of their head.( No pony tails, no loose hair)

       Only a plain white shirt under the uniform can be worn.

          No jackets can be worn in the Gurdwara or the classroom.

       During lunch time, Khalsa School Gym strip may be worn if desired, and is required during gym periods; no other PE clothes
        allowed. Shorts are not allowed.(except sports league tournaments)

       Khalsa school uniform must be worn on all FIELD TRIPS.

       Items not permitted: nail polish, make up, lipsticks, rings, necklaces, earrings, vests, flairs, jeans, baseball caps, shorts,
        tearaways or another personal item that are not permitted under the uniform.

       Amrit Dhari students must wear the five K’s.

       Check School Uniform information for more detail.

THIS IS NOT AN EXHAUSTIVE LIST OF SCHOOL RULES. ANY BREACH OF GOOD MANNERS OR OF DISCIPLINE IS A
BREACH OF SCHOOL RULES.

Dear Parents,

Please discuss the Code of Conduct with your child. Please make sure that it is understood so that there will be no misunderstandings.

Thank you for your co-operation.

Parent/Legal Guardian’s Signature_______________________________ Date ______________________________

Parents Name: ____________________________________________

Student Signature __________________________________                         Date_______________________________

Student’s Name (Please Print): ______________________________________

                                                                     12
Permission Letter for Publication of Students’ Work or Photographs on Websites

Dear parent or caregiver

I am writing to request your permission for photographs of your child to be taken during school activities. If photographs are taken,
this would be for the purpose of educating students, promoting the school, or promoting education. I am also seeking your permission
for the school to publish photographs, samples of your child’s work and also for broadcasting over television/ radio media or prepare a
CD/DVD of your child’s activities related to education.

If you give your permission, the school may publish photographs of your child and/or samples of work done by your child in a variety
of ways. The publications could include, but are not limited to, school newsletters (online and in hard copy), Khalsa School Internet or
intranet websites, school annual magazines and local newspapers. If published, third parties would be able to view the photographs
and work.

If you sign the attached form it means that you agree to the following:

1. The school is able to publish photographs of your child and samples of your child’s work as many times as it requires in the ways
mentioned above.

2. Your child’s photograph may be reproduced either in colour or in black and white.

3. The school will not use your child’s photograph or samples of your child’s work for any purpose other than for the education of
students, or for the general promotion of education and the school.

Any photographs taken by the school will be kept for no longer than is necessary for the above-mentioned purposes and will be stored
and disposed of securely.

Whilst every effort will be made to protect the identity of your child, Khalsa School cannot guarantee that your child will not be able
to be identified from the photograph or work.

If you agree please complete the consent form.

This consent, if signed, will remain effective until such time as you advise the school otherwise.

Consent Form for Publication of Students’ Work or Photographs

I agree, subject to the conditions set out above, to the taking of photographs of my child during school
activities, to be used by the school in educating students and promoting the school and public
education. I also agree to the publication of photographs or samples of work of my child. I will notify the
school if I decide to withdraw this consent.
Please circle one:---      yes or no
Student’s name: _______________________________________________Student’s Grade: __________

Signature of parent/caregiver: __________________________________Date: _____________________

Signature of student: _________________________________________Date: _____________________

                                                                   13
14
STATUS OF PARENT/GUARDIAN (ADMISSION TO CANADA AND RESIDENCY) – FORM A
                                      (If parents are deceased, use form B)

Student’s Name: _________________________________________________________ Grade _____
                Last name             First name

To be completed and signed by a parent or legal (court-appointed) guardian. (If legal guardian, attach copy of court order appointing you as legal
guardian).

(Lawfully Admitted into Canada)

     1.   I am (please X one):

                    A Canadian citizen (if not born in Canada, please attach a photocopy of citizenship paper/card)

                    A Permanent Resident (landed immigrant) (attach photocopy of landed immigrant status paper or PR card)

                    Lawfully admitted into Canada under the Immigration and Refugee Protection Act (Canada) with one of the following
                    documents (please mark the appropriate box below and attach photocopy of document):

                            Admission as a refugee or refugee claimant

                            Valid student permit for two or more years (or issued for one year but anticipated to be renewed for one or more

                            additional years)

                            Valid employment authorization (work permit) for two or more years (or issued for one year but anticipated to be

                            renewed for one or more additional years)

                     A person carrying out official duties under the authority of the Visiting Forces Act or as an accredited diplomatic agent,
                     preclearance officer, consular officer or official representative in Canada of a foreign government with a consular post in

                     British Columbia.

                     Other – Document description: (must be cleared with Citizenship and Immigration

                     Canada____________________________________________________________

                     __________________________________________________________________

(Residency in British Columbia)

2.        I am resident of British Columbia(please X one):

                 Yes Residency address: ________________________________________________
                      ________________________________________________________________
                    ________________________________________________________________
                   No I am not a resident of British Columbia

Confirming signatures:

3.        Parent/Legal Guardian’s name:          ___________________________________________________________

          Parent/Legal Guardian’s signature:     ___________________________________________________________

                                                                         15
Date:                                  ___________________________________________________________

STATUS OF DECEASED PARENT (ADMISSION TO CANADA AND RESIDENCY) – FORM B

Student’s Name: _________________________________________________________ Grade _____
                Last name             First name

To be completed and signed by the student or a knowledgeable adult (one who knew the student’s parent(s) and has knowledge of the facts
respecting their decease and the matters set out in this document)

(Deceased parent was Lawfully Admitted into Canada)

       1.   The student’s deceased Parent was at time of death:

            A Canadian Citizen

                     A Permanent Resident (landed immigrant)

(Deceased parent was Resident in British Columbia)

2.          The student’s deceased parent was at time of death a resident of British Columbia (please X one)

                    Yes Residency address: ________________________________________________
                        ________________________________________________________________
                       ________________________________________________________________

                     No I am not a resident of British Columbia

 Confirming signatures:

     Student:_______________________________________________________

     Knowledgeable Adult’s Name: _________________________________________________________

     Knowledgeable Adult’s Signature: ______________________________________________________

 (Knowledgeable Adult is one who knew the student’s parent(s) and has knowledge of the facts respecting their decease and   the matters set out
in this document)

     Date: __________________________________________________

                                                                         16
HEALTH HISTORY REQUEST

                                               Please COMPLETE and RETURN this form to the school or your local health unit.
                        This information will be used to assess the immunization status of the school population.

                                                       RECORD OF IMMUNIZATION
 CHILD’S NAME: SURNAME                    GIVEN NAME(S)                      BIRTH DATE:                 CARE CARD NUMBER
                                                                             YYYY MM          DD         (PHN)
 PARENT/GUARDIAN                                                      PHONE (HOME)                          PHONE (OTHER)

 ADDRESS                                                                                    CITY                     POSTAL CODE

 PREVIOUS ADDRESS (within last 5 years). Needed to request health unit records.             CITY/PROVINCE/COUNTRY

 SCHOOL ATTENDING IN SEPTEMBER                                     GRADE            PREVIOUS SCHOOL                  CITY

               **Please attach a COPY of immunizations OR fill in the DATES of all past immunizations below**
        DPTP-Hib                 MMR               Hepatitis B         MeningococcalC       Pneumococcal       Varicella
       (Diphtheria,        (Measles, Mumps,                              Conjugate           Conjugate        (Chickenpo
   Pertussis, Tetanus,          Rubella)                                                                           x)
   Polio, Haemophilus
   Influenza Type B)
           #1-                    #1-                  #1-                  #1-                   #1-              #1
           #2-                    #2-                  #2-                                        #2-            Age of
           #3-                                         #3-                                        #3-           Disease:
            #4-                                                                                               #4-

   DPTP –Kg Booster
      (Diphtheria,
   Pertussis, Tetanus,
         Polio)
           #5-

                       List any other immunizations received below or on the back of this sheet
  ________________________________________________________________________________________________________
  ________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
                                                 ______________

                                                            ATTENTION:
  If your child has any condition which may affect school performance, limit activity or require emergency care (eg. Epilepsy,
  diabetes, heart condition, asthma, severe allergy, etc.), it is the parents’ responsibility to inform the school and complete any
                                                        appropriate forms.
               Signature of Parent/Guardian:                                      Date Form Completed:              Public Health Nurse:

                                                               Revised June 24, 2008

                                                                          17
18
Consent form
I consent to the following:

    1. I agree to pay Tuition fees for the whole year regardless of whether I take the child out during the school year.

    2. $ 20 will be charged for NSF cheque or two times credit card payment decline

    3. I agree that all the fees are non- refundable.

____________________________________________
Parent’s Signature

____________________________________________
Parent’s Printed Name

_____________________
Date Signed

                                                           19
KHALSA SCHOOL SURREY
                                     6933 – 124 St. Surrey, B.C. V3W 3W6
                                          Telephone: 604-591-2248

                             Visa/MasterCard Pre-authorization payment form
                          Campus: Newton /Old Yale Road/ Khalsa Secondary School

Customer Information:

Name of Card holder: ______________________________________________

Address: _________________________________________________________

Telephone: _______________________________________________________

Visa/M/C Number: __________________________________________________

Expiry date: ________________________________________________________

Child/Children name & Grade: __________________________________________________

Pay to the account of Khalsa school Surrey: School fee: $______Bus fee $________

Payment frequency (Yearly/ Term Wise) _____________

Next payment due: January / April

All authorized signature required:

Customer Signature:_____________________Date:_____________________

Customer signature: ____________________ Date: _____________________

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