Continuing Education Learning Centres
OFFICE USE ONLY
Niagara Catholic District School Board
Mr. R. Di Persio, Principal
Ms. F. Abedin, Manager
Mr. M. DiVittorio, Vice-Principal
Mr. F. Wilson, Supervisor
905-682-3360
www.summerschoolniagara.ca
Grade 7 & 8 Summer School 2016 Application
Date Received:
Cash
Cheque No. __________
Visa or MC
Part A: Student Information
This number can be found on the top of your
school report card or from your home school.
OEN
Legal Last Name
Apt/Unit #
Legal First Name
Middle Name
Street Address
City/Town
Date of Birth (Month/Day/Year)
Telephone (Home)
Present School
Current Grade (circle one)
6
7
Male
Female
Postal Code
Telephone (Other)
School as of September 2016
8
Email Address
Country of Birth
Province of Birth
Status in Canada (circle one)
Citizen
Date of Entry to Canada, if applicable (MM/DD/YY)
Native Ancestry
Landed Immigrant
Refugee
Pertinent Medical Information, e.g. allergies
Parent/Guardian Last Name
First Language Spoken
International Student
Ontario Health Card Number
Parent/Guardian First Name
Telephone (cell/business)
Part B: Emergency Information
Emergency Contact
Emergency Contact Telephone
Part C: Program Information
Please check course(s) and location desired.
Please check course(s) and location desired.
Summer Activities Camp - ON CAMPUS
New Credit Courses - ON CAMPUS
For students entering Grade 7 or 8 in September, 2016
Sessions
Fees
Week 1 - July 4 - 8
For any one (1) week:
$100.00
Week 2 - July 11 - 15
For any two (2) weeks:
$175.00
Week 3 - July 18 - 22
For all three (3) weeks:
$250.00
Grade 8 students, entering grade 9 in September, 2016, only
July 4 - 29
Physical & Health Education - PAF2O* (offered only at DM, HC, LC)
Physical & Health Education - PAI2O* (offered only at BT, ND, SM)
*Attach $80 Field Trip/Excursion Fee; payable to NCDSB
Attach applicable fee; payable to NCDSB
Locations
Denis Morris HS (DM)
Holy Cross SS (HC)
Notre Dame CS (ND)
Blessed Trinity SS (BT)
Saint Michael HS (SM)
Lakeshore CHS (LC)
Part D: Summer Activities Camp Students - Teacher Recommendations (to be completed by the student’s home school teacher)
Subjects
(Please check appropriate Level)
Achievement
Level
Level 1
Strengths/Next Steps for Improvement --- Please be specific
Level 2
Language
Reading
Writing
Oral Communication
Media Literacy
Mathematics
Number Sense & Numeration
Measurement
Geometry & Spatial Sense
Patterning & Algebra
Data Management & Probability
NOTES:
Part E: Signature Section
All course offerings, locations, and times are tentative based on sufficient enrolment and subject to change.
For Transportation Availability and Information Refer To The Pupil Transportation Form @ www.summerschoolniagara.ca
FINAL EXAMS will take place within the last 3 days of a course and students are required to be in attendance.
I understand the program information outlined above and give permission for my child to attend.
Check box if student has an IEP.
Parent/Guardian Name
Date
Parent/Guardian Signature
This confirms that this student has my permission to participate in the Summer program detailed herein.
Principal’s Name
Principal’s Signature
Personal information on this form is collected under the authority of the Education Statutes and Regulations of Ontario and will be used to establish a student record and for administrative purposes by the Continuing Education Learning Centres of the Niagara Catholic District School Board. Questions about this collection should be directed to the Superintendent of
Education (Continuing Education), Niagara Catholic District School Board, 427 Rice Road, Welland, ON. L3C 7C1. Phone: 905-735-0240
Pink copy to student. Return White and Yellow copies to St. John Centre - 145 Niagara Street, St. Catharines