Fillable 2019 GR4HS 2019 Registration Form Fillable

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2019 GR4HS 2019 Registration Form Fillable

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DCE–GettingReadyforHighSchoolRegistrationForm2019
DURHAM CONTINUING EDUCATION
Getting Ready for High School
August 19 – 22, 2019* (some exceptions apply)
LOCATION(pleaseselectone)
AJAX .............. …Ajax HS
AJAX ………….. JC Richardson C
BROOKLIN .... …Brooklin HS
CANNINGTON….Brock HS*
(Aug 19 – 21)
OSHAWA………..Eastdale CVI
OSHAWA ……….GL Roberts CVI
OSHAWA………..Maxwell Heights SS*
(Aug 19 – 21)
OSHAWA………..O’Neill CVI
OSHAWA………RS McLaughlin CVI
PICKERING……..Dunbarton HS
PICKERING……..Pickering HS
PICKERING….....Pine Ridge SS
PORT PERRY….Port Perry HS
WHITBY…………Anderson CVI
WHITBY………. D A Wilson SS
WHITBY………..D A Wilson SS - French
WHITBY………..Henry St HS*
(Aug 19 – 21)
WHITBY……….. Sinclair SS
UXBRIDGE……..Uxbridge SS
BUS TRANSPORTATION
Bus Transportation – Rural Areas Only – Check one box: Port Perry HS Uxbridge SS
(schedules available at www.dce.ca) Brock HS
BUS STOP: ________________________________________
DEMOGRAPHICS (Basic Student Demographics)
Legal Last Name
(as shown on Proof of Citizenship)
Legal First Name
(as shown on Proof of
Citizenship)
Legal Middle
(as shown on Proof of Citizenship)
MALE
FEMALE
Preferred/Common Last Name Preferred/Common First Name
Home Phone:
Unlisted
Cell:
Date of Birth Proof of Age Document (copy attached) (Office Use Only)
Birth Cert Landed Immigrant Citizenship Card Other
Passport Student Visa Permanent Res. Card
Month Day
Y
ea
r
House
#
Street Name
Apt/Unit City/Town
Postal Code
Mailing Address
Same as above
Email Address
Parent/Guardian #1 (first & last name) Daytime Phone#
Parent/Guardian #2 (first & last name) Daytime Phone#
EDUCATION
Student’s Elementary Home School
School Student will attend in Fall 2019
OEN#
ADMISSION (Citizenship)
Country of Birth
If Canada, province of birth:
If outside Canada, Date of Entry (YYYY/MM)
Year Month
Citizenship Documentation (Office Use Only)
Canadian Other Visa Permanent Resident Student Visa
Refugee Status
Photo ID
Passport Driver’s License Current Student
ID
Other
______________________________________
Admit Date (Start Date) First Language All parents/guardians of Aboriginal students, and students who are 18 years or older, have the
right to voluntarily and confidentially self-identify their Aboriginal ancestry. If the student is
considered to be of Aboriginal ancestry, please check the appropriate box: First Nations
Métis Inuit
Month Day
Y
ea
r
Please read and sign the waiver and agreement of understanding on the reverse.
2019
DCE–GettingReadyforHighSchoolRegistrationForm2019
EMERGENCY (Emergency Contact)
Emergency Contact (If Parent/Guardian above
unavailable)
Emergency Contact Phone # Student Health Card #
Do you have health conditions and/or allergies that are life threatening? Yes No
If YES, please give details:
I choose not to disclose  Initial:
Student wears MedicAlert®
Registration No.
EpiPen required at summer school: Yes No
Administration of medicine required during summer school: Yes No
If, in the case of illness or accident my emergency contact cannot be reached by telephone, I hearby grant authority to the
Principal or designate to call an ambulance.
Yes
No
Student Registration Waiver – Please complete and sign
My child’s school work may be displayed in school buildings, school, or board publications and/or website articles in the
media.
I give consent
I do not give consent
My child’s photograph/visual likeness may be displayed in school buildings, school, or board publication and/or website
articles in the media.
I give consent
I do not give consent
I give permission for my name and phone number to be used by School Community Councils for the purpose of sharing
school information.
I give consent
I do not give consent
For the duration of summer school only, I hereby give my approval for Durham Continuing Education, a school
within the Durham District School Board, to access this child’s medical records that are on file at the home school
within the Durham District School Board.
I give consent
I do not give consent
Agreement of Understanding
To the best of my knowledge, the information on this form is correct.
I understand that:
o until all required documentation is complete i.e. proof of citizenship (where applicable) etc., the registration is NOT
complete and the SEAT WILL NOT BE HELD.
o regular attendance and punctuality are essential. All absences must be explained by a note signed by a
parent or guardian.
o due to the concentrated time and work load of summer school and the fact that participation is optional,
consistent attendance is recommended in order for the student to receive full benefit of the program.
o students will receive an assessment upon completion of each component of the program.
It is my responsibility to:
o immediately advise the school of changes in the information stated on this form.
o notify the summer school office of any absences or if I wish to withdraw from the program.
Student Signature Parent/Guardian Signature Date
Opening Day Procedures – Getting Ready for High School 2019
1. Students must bring this form.
2. The starting time for each school is 8:30 AM.
3. The room location for classes will be posted in the school on the first day.
4. The teacher will provide textbooks or other learning materials for classes.
5. Please note – there is no on-site food service at summer school. Students will be given time for nutrition breaks.
NOTE: Summer school may not be appropriate for the success of identified students who receive modification or
accommodations to their program during the school year. As summer school is an optional program, additional support for
identified students is not always available.
Ways to Register: On-line: www.dce.ca By Phone: 905.436.3211 OR 1.800.408.9619
By Fax: 905.436.1780 In person or by mail: Durham Continuing Education
120 Centre St. S Oshawa ON L1H 4A3
Direct Inquiries to: DURHAM CONTINUING EDUCATION, 120 CENTRE ST. S., OSHAWA ON L1H 4A3
905.436.3211 or 1.800.408.9619 Email: michele.reid@ddsb.ca
www.dce.ca
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Completed 21 July 2020

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