Fillable Form 2: Grade 11, Leadership & Peer Support (Grand Erie District School Board)

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Form 2: Grade 11, Leadership & Peer Support (Grand Erie District School Board)

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SUMMER 2021 INDIGENOUS CLASS REGISTRATION
Grade 11, Leadership & Peer Support (GPP3O.1)
2
319 Third Line, Ohsweken, Ontario
(519) 753-6079 www.granderie.ca
Deadline: June 25, 2021 – email to: summerregistration@granderie.ca
Legal Last Name
Legal First Name
Middle Name
☐ Male ☐ Female ☐ Other
OEN
Present School Name and School Board Name
Student Email (used in school)
Parent Email
Date of Birth (MM/DD/YYYY)
Address (No. & Street, City/Town, Province, Postal Code)
Current Grade
Home Phone
Parent/Guardian #1 Name & Phone
Emergency Contact Name
Canadian Citizen ☐
Permanent Resident
☐
(If no, please submit immigration documents)
Self-Identification
(voluntary)
☐ First Nations
☐ Metis ☐ Inuit
Student Lives on:
☐ Six Nations Grand River
☐ Mississaugas of the
Credit
Note: This is an in-person class to be held at 2319 Third Line, Ohsweken, Ontario with prescribed safety
protocols. *Please email this registration form to summerregistration@granderie.ca. You will receive
further course details by the last week of June, 2021.
Parent/Guardian signature (for all students under age 18 years):
Student Signature:
July 6, 2021 to July 30, 2021
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Form 2: Grade 11, Leadership & Peer Support (Grand Erie District School Board)

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Completed 27 June 2021

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