Les amis French Camp Farley Mowat P.S. 2018

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OCDSB Continuing Education International Languages Elementary Program Registration Form

A. Student Information

Eligibility: Students from JK to Grade 8 enrolled in Core French or Immersion Program

Child's First Name: *

Child's Last Name: *

Date of Birth: *

YYYY

Age at time of camp attendance: *

Gender *

Present Day School: *

Current Day School Grade: *

Eligibility: Children from JK to grade 8

Please select one: *

B. Student Address Information:

Street Number & Name: *

Apartment #:

City: *

Postal Code: *

C. Parents / Guardians Information:

PARENT/GUARDIAN #1: First Name *

PARENT/GUARDIAN #1: Last Name *

PARENT/GUARDIAN #1: Mobile #: *

PARENT/GUARDIAN #1: Home #:

PARENT/GUARDIAN #1: Email Address: *

PARENT/GUARDIAN #2: First Name

PARENT/GUARDIAN #2: Last Name

PARENT/GUARDIAN #2: Mobile #:

PARENT/GUARDIAN #2: Home #:

PARENT/GUARDIAN #2: Email Address:

D. EMERGENCY CONTACT INFORMATION:

Emergency Contact's First & Last Name: *

Emergency Contact's Mobile #: *

E. Student Medical Information:

If your child has no serious medical conditions, please write the word "NONE".

Medical Condition / Allergy: *

F. Special Needs:

If your child has any special education needs or an IEP, please let us know so that we may accommodate your child's needs.

Special Education Needs: *

NONE

Learning Disability

ADHD

Autism

Other

Required

F. Media Release Permission:

Photos, videos or interviews will only be done with the prior knowledge and consent of the school principal and will not be used for commercial gain. I/we hereby consent to the inclusion of photographs of my/our child in the following:

Check all the you give permission for: *

photographs for sharing on school website and email blog

videos or interviews as part of a school related activity

school board publications produced by the OCDSB Communications Office

photographs for use on school Internet pages and OCDSB public websites

Required

I wish to enroll my child in the Les amis Summer Language Program for the following weeks (9 am to 4pm: *

FULL

Week 3: July 16 - 20, 2018 (COST $210.00)

Week 4: July 23 - 27, 2018 (COST $210.00)

Required

We will need the optional childcare (pre & post care from 8-9 am and 4-5 pm) COST PER WEEK: $50 ($40 for 4 day week) *

Week 1: July 3 - 6, 2018 (4 days only COST $40.00)

Week 2 July 9 - 13, 2018 (COST $50.00)

Week 3: July 16 - 20, 2018 (COST $50.00)

Week 4: July 23 - 27, 2018 (COST $50.00)

No pre & post care needed.

Required

REFUND POLICY: Fees are non-refundable, except with medical certification. Registration is on a first come, first served basis and the program will be offered subject to enrollment. Reservation of your spot will be created upon registration. Payment is required A.S.A.P. to guarantee your spot.

Please make cheque payable to OCDSB Continuing Education and drop off at Farley Mowat PS- Attention Nadine Saikaley on Saturday mornings during the ILE or send by Mail to OCDSB Albert Street Education Centre, Continuing Education - International Languages, E121 - 440 Albert Street, Ottawa, Ontario, K1R 5B5 PLEASE WRITE YOUR CHILD'S NAME on the CHEQUE for reference.

By clicking I agree, you are acknowledging that you have read and agree to the REFUND POLICY as stated above. *

I have read and agree to the REFUND POLICY stated above.

Required

Signature of Parent / Guardian:

By entering your name below you are indicating that all the information on this form is true and accurate, to the best of your knowledge.

Date:

YYYY

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