DSBN Home School Form

I/We here with provide the names, gender and date of birth for each child of compulsory school age for whom I/we intend to provide home schooling.

Child Information

	First Name of Child(ren)	Last Name of Child(ren)	Gender (optional)	Date of Birth	Grade	Last school attended
Remove	*Required	*Required		Required Wrong Format

Parent / Guardian Information

Name of Parent / Guardian:

Email:

Phone:

Home Address:

City:

Postal:

Mailing Address (if different from home):

City:

Postal:

Signature of Parent / Guardian:

Saved Signature:

Would you like to add another Parent / Guardian?

I/We wish to notify the District School Board of Niagara that I/we will be providing home schooling for our child(ren) starting in month year I/We understand our responsibility under the Education Act to provide month/year satisfactory instruction for our school-age child(ren) and do hereby declare our intent to do so.

Personal information on this form is collected, used and disclosed in accordance with the Education Act, R.S.O. 1990, c.E.2, as amended and the Municipal Freedom of Information and Protection of Privacy Act. R.S.O 1990, c.M. 56, as amended and will be used for the purpose set out in the Education Act and Ministry of Education Policy/Program Memorandum related to home schooling and any similar or related purpose(s). Questions about this collection, use and disclosure should be directed to the Freedom of Information Coordinator, District School Board of Niagara, 191 Carlton Street, St. Catharines, ON L2R 7P4 905-641-1550.