Saturday School Registration Form: Session 1 (Nov 7 – Dec 12, 2026) Saturday School Registration FormWe invite you to apply to our Saturday School, an incredible opportunity to learn with us on Saturday mornings at Star Academy, based around our five pillars of child development! Our Athletic, Academic, Social, Emotional and Global Pillars guide our planning.Session 1: Now Accepting Applications (6 week programme)Saturday November 7 to Saturday December 12, 2026Programme Cost: $300Session 2: Opens in November 2026 (8 week programme, details to come)Session 3: Opens in January 2027 (10 week programme, details to come)General Information for All ParticipantsFirst Name Parent 1*Last Name Parent 1*Mailing Address (Parent 1)* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent 1 Daytime Phone Number*Parent 1 Cell #*Parent 1 Email* First Name Parent 2Last Name Parent 2Parent 2 Mailing Address Same as Parent 1 Mailing Address (Parent 2) Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent 2 Daytime Phone NumberParent 2 Cell #Parent 2 Email Saturday School InformationBook your spot and complete your registration for the Saturday School.Total number of children applying*1234Child #1 InformationChild's First Name*Child's Last Name*Age*Date of Birth (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Gender*MaleFemaleCurrent School Grade*Current School Your Child is Attending*Child #1 Medical InformationHealth Card Number*Version Code*Health Card Expiry Date (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Family Doctor*Doctor's Phone Number*Immunization Up-to-date*YesNoDoes your child have any behavioural issues/special needs?*YesNoPlease describe the behavioural issues/special needs*Please review the list and checkmark any conditions that apply to your child.* Asthma Diabetes Eczema Epilepsy Frequent Nosebleeds Heart Condition Headaches Hay Fever Hepatitis Hearing Problems Tuberculosis Skin Problems Seizures Urinary Problems ADHD Other Conditions None Please describe the other condition(s)*Does your child require prescription glasses?*YesNoDoes your child have any allergies?*YesNoPlease list your child's allergies*Does your child have an Epi-Pen?*YesNoIf yes, medical alert bracelet recommended & 2 EPI-PENS MUST be provided. Epi-Pen must be carried at all times.Does your child have any dietary/food restrictions?*YesNoAre there any foods your child should not eat for medical, dietary or religious reasons?Other medical conditions and/or allergiesChild #2 InformationChild's First Name*Child's Last Name*Age*Date of Birth (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Gender*MaleFemaleCurrent School Grade*Current School Your Child is Attending*Child #2 Medical InformationHealth Card Number*Version Code*Health Card Expiry Date (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Family Doctor*Doctor's Phone Number*Immunization Up-to-date*YesNoDoes your child have any behavioural issues/special needs?*YesNoPlease describe the behavioural issues/special needs*Please review the list and checkmark any conditions that apply to your child.* Asthma Diabetes Eczema Epilepsy Frequent Nosebleeds Heart Condition Headaches Hay Fever Hepatitis Hearing Problems Tuberculosis Skin Problems Seizures Urinary Problems ADHD Other Conditions None Please describe the other condition(s)*Does your child require prescription glasses?*YesNoDoes your child have any allergies?*YesNoPlease list your child's allergies*Does your child have an Epi-Pen?*YesNoIf yes, medical alert bracelet recommended & 2 EPI-PENS MUST be provided. Epi-Pen must be carried at all times.Does your child have any dietary/food restrictions?*YesNoAre there any foods your child should not eat for medical, dietary or religious reasons?Other medical conditions and/or allergiesChild #3 InformationChild's First Name*Child's Last Name*Age*Date of Birth (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Gender*MaleFemaleCurrent School Grade*Current School Your Child is Attending*Child #3 Medical InformationHealth Card Number*Version Code*Health Card Expiry Date (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Family Doctor*Doctor's Phone Number*Immunization Up-to-date*YesNoDoes your child have any behavioural issues/special needs?*YesNoPlease describe the behavioural issues/special needs*Please review the list and checkmark any conditions that apply to your child.* Asthma Diabetes Eczema Epilepsy Frequent Nosebleeds Heart Condition Headaches Hay Fever Hepatitis Hearing Problems Tuberculosis Skin Problems Seizures Urinary Problems ADHD Other Conditions None Please describe the other condition(s)*Does your child require prescription glasses?*YesNoDoes your child have any allergies?*YesNoPlease list your child's allergies*Does your child have an Epi-Pen?*YesNoIf yes, medical alert bracelet recommended & 2 EPI-PENS MUST be provided. Epi-Pen must be carried at all times.Does your child have any dietary/food restrictions?*YesNoAre there any foods your child should not eat for medical, dietary or religious reasons?Other medical conditions and/or allergiesChild #4 InformationChild's First Name*Child's Last Name*Age*Date of Birth (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Gender*MaleFemaleCurrent School Grade*Current School Your Child is Attending*Child #4 Medical InformationHealth Card Number*Version Code*Health Card Expiry Date (mm/dd/yyyy)* Date Format: MM slash DD slash YYYY Family Doctor*Doctor's Phone Number*Immunization Up-to-date*YesNoDoes your child have any behavioural issues/special needs?*YesNoPlease describe the behavioural issues/special needs*Please review the list and checkmark any conditions that apply to your child.* Asthma Diabetes Eczema Epilepsy Frequent Nosebleeds Heart Condition Headaches Hay Fever Hepatitis Hearing Problems Tuberculosis Skin Problems Seizures Urinary Problems ADHD Other Conditions None Please describe the other condition(s)*Does your child require prescription glasses?*YesNoDoes your child have any allergies?*YesNoPlease list your child's allergies*Does your child have an Epi-Pen?*YesNoIf yes, medical alert bracelet recommended & 2 EPI-PENS MUST be provided. Epi-Pen must be carried at all times.Does your child have any dietary/food restrictions?*YesNoAre there any foods your child should not eat for medical, dietary or religious reasons?Other medical conditions and/or allergiesTerms & Conditions*Please be advised that failure to disclose or providing false medical information regarding medical conditions or prescription medications will result in dismissal from our camp programs. There are no refunds on all fees paid.Medical Consent StatementI understand that in the event of an accident or illness, occurring to my child, Star Academy/Star Academy Saturday Schools will make every attempt to contact me and/or my child's other parent. I hereby give Star Academy/Star Academy Saturday Schools authority to act on my behalf to take whatever steps are necessary to obtain emergency medical care if warranted. These steps may include, but are not limited to, the following:Attempt to contact the child's physician.Attempt to contact the emergency contact.Call another physician.Call an ambulance.Have the child taken to the emergency department of a hospital, in the company of a staff member of Star Academy/Star Academy Saturday School.Medical Consent* I have provided Star Academy Saturday School with all necessary medical information and I can be reached at the number listed within the application form. I authorize staff to administer First Aid to my child in an emergency as deemed appropriate by the attending physician(s). I authorize first aid measures by the best qualified person on hand at the time of any emergency. I hereby waive any claims against anyone administering first aid. I understand the school will make all possible efforts to reach me prior to any treatment. Codes of BehaviourStudents must be respectful to the program supervisors and their peers at all times.Students must be respectful of school materials and the facility.No verbal or physical harassment will be accepted under any circumstances.Students should bring energy and a positive attitude each day they participate in our program.Students agree to adhere to all safety and security protocols.*Please be advised that failure to follow the Saturday School/Camp Code of Behavior may result in withdrawal from our camp programs. There are no refunds on all fees paid.Codes of Behaviour* I have read and agree to the above Payment/RefundsI understand that all fees paid are non-refundable, non-transferable and subject to change without notice. A complete payment is due upon completion of the application form. Please allow 5 business days to process your changes. There are no refunds on any differences or over-payments. No refunds will be issued for days missed for any reason.Refund Policy: Fees are non-refundable.Late Policy: A surcharge of $1.00 per minute will apply to all students picked up after the child care time of 12:00 pm.Program changes due to registration, weather, etc. may be made at the school's discretion, without notice. Should any unforeseen circumstances arise which are beyond our control, including but not limited to: acts of God, riots, war, terrorist acts, epidemic, pandemic, quarantine, civil commotion, breakdown of communication facilities, breakdown of web host, breakdown of internet service provider, natural catastrophes, governmental acts or omissions, changes in laws or regulations, national strikes, fire, explosion, accidents, generalized lack of availability of raw materials or energy, etc. Star Academy/Star Academy Saturday Schools reserves the right to make changes to our programs (i.e. academic and dormitory arrangements, cancellations or re-scheduling of programs as deemed necessary, acceptance or admission to Star Academy/Star Academy Saturday Schools' programs or the deferral thereof and access to Star Academy/Star Academy Saturday Schools' premises and facilities), without any liability, whatsoever.It is the parent/guardian's responsibility to provide Star Academy/Star Academy Saturday School staff with written notification of changes or new student information, including that of returning students from previous years.Payments* I, the undersigned, understand and agree that all payments, installments and deposits are non-refundable and non-transferable and subject to change without notice. Accuracy of Information* I hereby certify that all information contained on these forms are accurate and complete. School Policies* I acknowledge that breaching any school policies, procedures, rules and/or regulations (including updates that are made from time to time) may result in immediate cancellation of enrollment and forfeiture of any fees paid. Acceptance* I understand that acceptance into Star Academy Saturday School program will be based on availability and first-come first-serve basis. Release and Waiver of LiabilityIn consideration of the acceptance of this application and the permission given by myself as guardian of the aforementioned child, I as parent of the minor child and on behalf of myself, my heirs, executors, administrators and assigns hereby forever discharge and release Star Academy/Star Academy Saturday Schools, its respective officers/ directors, managers, servants, agents or employees from any claims, demands, damages, actions or causes of actions arising out of or in consequence of any loss, injury or damage to my person or property incurred while the child is attending at or participating in the Star Academy Saturday School program or participating in the aforementioned activity notwithstanding any such loss, injury or damage may have arisen by reason of the negligence of Star Academy/Star Academy Saturday Schools, its respective officers/directors, managers, servants, agents or employees.Release and Waiver of Liability* I am aware that there are inherent risks and dangers associated with the participation in the Saturday School Program and I hereby agree as parent of the said child to assume in their entirety these risks as my own responsibility. Does your child have any diagnosis, or suspected diagnosis (Learning Disability, ADHD, Autism Spectrum Disorder, Communication Disorder, etc...) that could impede their ability to fully participate in Saturday School? If YES please describe in detail below.If registering more than one child, please indicate which child your answer refers to.Do you have any concerns about your child's participation in Saturday School?If registering more than one child, please indicate which child your answer refers to.Has the student ever withdrawn or been dismissed from a camp, an academic institution or a co-curricular program?If registering more than one child, please indicate which child your answer refers to.Does the student receive or require educational support in their school environment?If registering more than one child, please indicate which child your answer refers to.Programme RegistrationPlease register my child for the following:* Saturday School Session 1: November 7 – December 12, 2026 (Cost: $300 per child) Saturday School Session 1 Fee Price: $0.00 $300 per child, calculated from the number of children applying.Total $0.00 Payment Method*CashChequeE-Transfer to: finance@staracademy.caPlease make a note on the cheque or e-transfer (student name / payment made for Saturday School) and the payment will be non-refundable.Emergency Contact 1Emergency contact other than parentContact Name*Relationship*Daytime Phone*Other PhoneEmergency Contact 2Emergency contact other than parentContact NameRelationshipDaytime PhoneOther PhoneTransportation InformationPlease indicate people permitted to pick up your child from Star Academy.Authorized Pick-up Name*Authorized Pick-up Phone*Authorized Pick-up Name (2)Authorized Pick-up Phone (2)My child may use public transport/walk/bike (with a helmet on) home from school*YesNoPlease provide details of travel, bus route number, time and details of the student's travel*Photo Consent: All photos are used responsibly and with care. No use of names.*YesNoRegistrationNOTE – by sending the form and payment you consent to the Waiver Conditions below.WaiverThe Saturday Schooler and parents acknowledge and agree that Star Academy or camp directors, officers, or employees, will NOT be held responsible for any accident damage, injury, or loss, however, caused, negligent, or otherwise, at any time and expressly releases any and all the aforementioned parties from all claims arising from any accident, damage, injury or loss or as a consequence thereof. Also, parents/guardians hereby authorize Star Academy staff to seek any emergency medical treatment it deems necessary for their child/ren or legal dependent. Parents/guardians authorize the use of any photos taken at the Star Academy Saturday School program for promotional purposes.I/We agree to pay any damages or debt incurred by Star Academy as a result of the student defacing, damaging, removing, or misusing any school property (inclusive of false fire alarms). I/We agree to pay to Star Academy within 30 days of notice by Star Academy thereof.By clicking YES and submitting this form, I, the Parent / Guardian, certify I have read the conditions above and agree to participate having read them.Cancellation PolicyThere are no refunds after registration.Allergy AcknowledgementWithin our community, there are several students who have a potentially life-threatening allergy (anaphylaxis) to foods, predominantly to peanuts and tree nuts (e.g., almonds, cashew, hazelnut, pistachio). The best way to reduce the risk of accidental exposure to these students is to respectfully ask for the cooperation of the parents within our students to avoid sending peanut butter or products with peanuts or other nuts listed in the ingredients. Due to anaphylaxis and also a variety of food sensitivities, all parents are asked to consult with the office in advance of sending in food to celebrate a child's birthday or other special occasions. You are encouraged to consider non-food items for these events so that all children may participate in the fun.Thank you for helping us to provide an 'allergy-safe' environment for children at risk of anaphylaxis. Your cooperation and understanding of this matter is appreciated.I hereby give permission for my child to participate in the SATURDAY SCHOOL provided by Star Academy Mississauga, along with any/all activities associated with this week*YesNoHow did you hear about our Saturday School?*Signature, Date & SubmissionParent Signature*Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
