International Student Application

International Student Application
Thank you for applying to the International Program at Highroad Academy. Please have a copy of your child's passport, school report cards from the last two years, and a current immunization record ready to upload in this application.
Date*

MonthDayYear
Please enter today's date
Student Information
Student's Name*

First NameLast Name
English Name*
Date of Birth*

MonthDayYear
Student's Date of Birth
Citizenship*
Gender*
Please attach a copy of the student's passport*

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Home Address*

Street Address

CityCountry

Postal / Zip CodeCountry
Father's Name*

First NameLast Name
Father's Occupation*
Father's Date of Birth*

MonthDayYear
Date
Father's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Father's Email Address*
example@example.com
Mother's Name*

First NameLast Name
Mother's Occupation*
Mother's Date of Birth*

MonthDayYear
Date
Mother's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email Address*
example@example.com
Are there other children in the family?*

YesNo
If yes, how many?*
Sibling's Name (1)*
Sibling's Age (1)*
Sibling's Gender (1)*
Sibling's Name (2)*
Sibling's Age (2)*
Sibling's Gender (2)*
Sibling's Name (3)*
Sibling's Age (3)*
Sibling's Gender (3)*
Sibling's Name (4)*
Sibling's Age (4)*
Sibling's Gender (4)*
Agent Information
Agent's Name*

First NameLast Name
Agent's Company Name*
Agent's Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Agent's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Agent's Email*
example@example.com
School Information
Please list the name of the school previously attended.*
School's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student's Current Grade in School*
Please attach a copy of the student's report card from the last 2 years*

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Does the student currently have any special needs in the education system?*

YesNo
If yes, what kind of learning needs or special education support does the student have?*
Has the student been diagnosed or suspected with any of the following issues? (Select all that apply)*

ADD/ADHDAnxietyBehavioral issuesAutismNone of the above
If the student has any assessments, reports or Individual Education Plans, please upload a copy here.*

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Medical Information
Please attach an immunization record for the student.*

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Does the student have any allergies or life-threatening medical condition?*

YesNo
If yes, please explain:*
Does your child have any special needs: physical, dietary, emotional?*

YesNo
If yes, please explain:*
Does your child have any allergies (eg. Food, animals)?*

YesNo
If yes, what is your child allergic to?*
What are the symptoms and how is it treated?*
Will your child be bringing any medications with him/her?*

YesNo
If yes, please explain what it is used for and how it is used.*
Program Information
Program Start Date*

MonthDayYear
Date
Program End Date*

MonthDayYear
Date
Preferred Grade Placement*
All students visiting Canada must have medical insurance. Please choose one of the following:*

I have my own medical insuranceI wish to purchase medical insurnace through Highroad Academy
Insurance Company *
Policy Number*
Homestay Arrangements
Please select one of the following options*

I will be staying with a family memberI need a homestay placement
Host families vary greatly. Some host families may have young children, older children, or none at all. Some may be single parents or retired. Please understand that Canada is a multicultural country, and that customs and traditions of some families may be different from other families.
Please write a short letter to your homestay family. Tell why you want to attend the school and live in Canada with a Canadian family. Write about your skills, interests, expectations, etc:*
Food Preferences: What are your favourite foods?*
What foods do you not like to eat?*
Are you allergic to any foods?*

YesNo
If yes, what?*
Please check all that apply:*

I like trying new foodsI like to eat a big breakfastI don't usually eat breakfastI like to eat a big lunchI like to eat a big supperI eat a lotI don't eat very much
Your lifestyle: check all that apply:*

I like living with young childrenI prefer children my ageI like children older than meI do chores at homeI clean my roomI prefer an active homeI prefer a quiet homeI like petsI don't like petsI am allergic to pets
What kind of pets are you allergic to?*
Please note that requests will be considered but cannot be guaranteed.

To the best of my knowledge, I declare that all information on this application is accurate. I understand that it is the student’s responsibility to accept the homestay placement offered by the school and make every effort to fit into the homestay family’s lifestyle.

I also understand that they have no obligation to replace me into another homestay family if I have not indicated in this application any allergies, dietary needs, medical conditions, or any other information, which could be essential to the placement of homestay family.
Student's Signature*

Clear
Date*

MonthDayYear
Date
Additonal Information
Please upload a photo (or two) of your family.*

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Tell about your family (parents, siblings, grandparents):*
What do you do for fun?*
Why do you want to attend school in Canada?*
What school subjects do you like or dislike?*
My attitude towards school is:*

I like it a lotIt's OKI don't really like it
What do you feel will be the best part about coming to Canada and what will be the hardest, or most difficult for you?*
Describe any concerns you may have about living in Canada:*
Personal Interests
Do you play an instrument?*

YesNo
If yes, what kind?*
Do you have any pets?*

YesNo
If yes, what kind?*
Interests, check all that apply:*

ActingBadmintonBaseballBasketballCampingDanceFootballGolfHikingMartial ArtsMoviesPainting/DrawingPhotographyReadingRunningShoppingSingingSkiing/SnowboardingSoccerSwimmingTravellingVideo GamesVolleyballWriting
Your personality: check all that apply.*

ActiveFriendlyFunnyHappyHelpfulLeaderListenerLike to studyMessyOrganizedOutgoingQuietShyTalkative
Student's Commitment
This section must be read and understood by all students applying for Highroad Academy. Students entering grade four through twelve must sign below, indicating that they have read and commit to abiding by these standards. Please check the following and sign below.
As a student of this Christian school:*

I will act in an orderly and respectful manner.I will maintain Christian standards in courtesy, kindness, morality and honesty.I will strive to be of unquestionable character in dress, conduct and all other areas of life.I agree to abide by the above standards of conduct and other regulations of Highroad Academy. I will uphold the school's standards against cheating, swearing, smoking, pre-marital sex, drinking alcoholic beverages, gambling, using or talking favorably about narcotics and using indecent language.I will not give the impression to students, parent, faculty or the community that I am not in harmony with the goals, aims and standards of this Christian school.I understand the scriptural importance of being committed to a local church.I am committed to weekly attendance at my local churchI am committed to weekly attendance to my local church's youth group.I want to attend this school.
Student's Signature*

Clear
Date Signed*

MonthDayYear
Date
Conditions of Registration
Please check the following:*

We have read and agree to support the Student's Commitment and fully understand the commitment our child is making.We support the Discipline Policy as outlined in the Student Handbook.We commit to assume our contractual responsibility to financially support the school by paying all tuition and other fees in a timely manner.We have attached a copy of the student's report cards and passport.
Verification

We certify that the above information is true and accurate to the best of our knowledge. We agree with and commit to abide by the information laid out in this application, including the parental and student commitments.

We hereby authorize Highroad Academy to verify all information provided, including but not limited to financial, criminal, medical, and scholastic information. We further authorize any previous schools our child attended to release any pertinent information requested by Highroad Academy.
Parent's Signature:*

Clear
Date*

MonthDayYear
Date
Parent's Signature:

Clear
Date

MonthDayYear
Date
Should be Empty: