Registration Package

Student Name: Campus:

Referral Date: Meeting Date: Present at Information Meeting: Follow up?:

Ensure the following documents are completed: Pathway Planning Sheet

SCDSB Registration Form

o Confirm address (if possible), complete in full

Computer Use Agreement Signed

Consent for Photograph & Group Acitivity

Student Medical Health Data

Statutory Declaration (if living with adult other than parent under age 17)

Insurance Letter

Materials to Handout to student/parent/guardian Copy of Alt School Brochure School Calendar Student Timetable

Keep a copy of all documentation on site Send all documentation to Joy;

Confirm first day of attendance with Joy

Simcoe Alternative Secondary School

Planning a Pathway

Have you had a chance to tour the facility? Have you seen the schedule for the day? Knowing the setup of our classrooms and the schedule for the day please comment on how you see yourself fitting into the school environment here?

Please confirm, you have ____ credits. Is there anything else we need to know? Any outstanding work we need to review? Recoverable credits? Who were you working with at your previous school? Confirm community service hours. IEP?

Teacher

• The Planning a Pathway is used during the meeting with the Student/Parent (Guardian)

• Ensure all aspects are complete before returning it to main office

Student

• Honesty and commitment are keys to the success here at ALT

• We have a few questions to help us plan for your success, OK?

Parent/Guardian

• Attendance is important and communication with the school is critical, we are looking for your support with these two pieces of our success strategy

• Can you help us with this? Email? Phone?

• We will keep this form on file for one year, to assist us with educational planning.

A positive learning and teaching environment is

essential if students are to succeed in school.

Please comment on any school connections you have. Could you describe why the previous school was not successful for you? Why do you predict that this school will be better?.

Your discipline record will be reported in your OSR which will move to our school. Please describe any suspensions that you currently have or have had in the past.

Are there any community support agencies you are

currently working with that may need to contact

you at the school or that we need to be aware of at

this time?

Finishing education at adult and continuing

education

Graduation with SDCSB Alternative School

College in the future

Workplace

Would you consider dual credit? (at a college

facility)

University

We generally offer grade 11 and grade 12 courses at the workplace, college level. How will this fit with your educational needs?

Period 1:

Period 2/3:

Alternative Education is a board system invention, meant to reengage students and provide support for students experiencing challenges with our regular models of education in SCDSB. We need to begin the conversation about next term? Next Semester? Next Year?

Busing? How will you get to school?

How can the school help you be successful? With attendance? With academics?

How will you get to school?

Page 1 of 2

STUDENT REGISTRATION FORM School Name Date

SCHOOL USE ONLY

Homeroom HR Teacher Tuition Paid By Family Courier Y N

STUDENT INFORMATION PROPERTY ADDRESS Verified

Initial

Legal Last Name Street # Street Name

Legal First Name Apt. # Township

Preferred Last Name Province ON Postal Code

Preferred First Name MAILING ADDRESS

Middle Name Same as Property Address Y N Complete if different

Third Initial Gender M F Street # Street Name

Birth Date DD/MMM/YYYY

Verified Source

Initial

Apt. # P/O Box R.R.#

Home Phone # Grade Entering

City Postal Code

IMMIGRATION INFORMATION

Country of Birth Citizen of Entry Date into Canada

Expiration Date

First Language Language at Home Verified Source: Initial

Citizenship Canadian Citizen

Permanent Res. Landed Immigrant

Work or Study Permit – Parent

Refugee

Exchange

Other(Specify) (i.e. International Student)

PREVIOUS SCHOOL INFORMATION

Name of Last School Attended Last Date of Attendance

School Address Phone Number

Is this a Simcoe County School? Y N If No, please fill in a School Immunization History Form Type of School

Elementary

Secondary

Private

Other

If No, has this student previously attended a Simcoe County School?

Y N If yes, Name of School:

Year Attended

Was student’s name the same as above? If not specify:

FOR SECONDARY STUDENTS ONLY Is Student Currently on Suspension or Expulsion?

Y N Does student have an IEP?

Y N Successfully completed the Ontario Secondary Literacy Test?

Y N Number of Completed Community Service Hours

PARENT/GUARDIAN INFORMATION

Is there a legal document that sets out custody and access to the student? Y N Is there any other information that the school needs to ensure the safety and security of your child?

Y N

Custody Both Parents

Mother

Father

Joint

Other Verified Source

Initial

1. Relationship Lives with Student Y N 2. Relationship Lives with Student Y N

Last Name First Name Last Name First Name

Same Address as Student Y N If No, complete address below

Same Address as Student Y N If No, complete address below

Street # Street Name Street# Street Name

Apt# City Apt# City

Province Postal Code Province Postal Code

Home Phone Bus. Phone Ext. Home Phone Bus. Phone Ext.

Cell Phone E-mail Cell Phone E-mail

Work/Employment Available at Work Y N Work/Employment Available at Work Y N

NOTE: OFFICIAL DOCUMENTATION WILL BE REQUIRED TO VERIFY INFORMATION PROVIDED.

Page 2 of 2

STUDENT NAME PARENT/GUARDIAN INFORMATION - Continued

3. Relationship Lives with Student Y N 4. Relationship Lives with Student Y N

Last Name First Name Last Name First Name

Same Address as Student Y N If No, complete address below

Same Address as Student Y N If No, complete address below

Street # Street Name Street# Street Name

Apt# City Apt# City

Province Postal Code Province Postal Code

Home Phone Bus. Phone Ext. Home Phone Bus. Phone Ext.

Cell Phone E-mail Cell Phone E-mail

Work/Employment Available at Work Y N Work/Employment Available at Work Y N

EMERGENCY CONTACTS (OTHER THAN PARENTS)

Last Name First Name Last Name First Name

Home Phone Bus. Phone Ext. Home Phone Bus. Phone Ext.

Cell Phone Relationship Cell Phone Relationship

Authorized to Collect Child from School? Y N Authorized to Collect Child from School? Y N

SIBLINGS (Who are currently registered in a SCDSB school)

1. Name: 2. Name 3. Name 4. Name

Relationship Relationship Relationship Relationship

Grade Grade Grade Grade

School School School School

MEDICAL (Complete Medical Emergency Plan and Administrative Procedures, if required)

Allergies & Health Concerns: Is this a Life Threatening Condition?

Y N

Medication and Emergency Procedures

ABORIGINAL SELF-IDENTIFICATION – VOLUNTARY

I consider my child to be of Aboriginal ancestry:

Y N Aboriginal Ancestry Type First Nation Status

First Nation Non-Status

Métis

Inuit

First Language Ojibwe

Cree

Oji-Cree

Mohawk

Michif

Inuktitut

English

Other (Specify)

Personal Information is collected pursuant to the Simcoe County District School Board Policy 4195, Volunteer, Confidential Self-Identification of Aboriginal Students in accordance with the Ministry of Education First Nation, Métis and Inuit Education Policy and the Municipal Freedom of Information and Protection of Privacy Act. Information collected shall be included in the Ontario Student Record (OSR) and shall be used for the provision of educational services for students in accordance with the policy. Questions regarding this policy may be referred to the Principal of the school.

ATHLETIC ELIGIBILITY - SECONDARY ONLY

Athletic Eligibility at this school may be restricted under certain circumstances for the next 12 months if the student is transferring from another Ontario high school. If the student wishes to be involved in athletics at the new school, please inquire about O.F.S.A.A. transfer policy.

I certify that the information that I have provided on this form is accurate and current to the best of my knowledge. I understand that copies of Custody documentation, if applicable, will be included in the OSR. Parent/Guardian/ Adult Student

Please Print

Signature

Date

Personal information collected on this form will be used to establish the Ontario Student Record (OSR), support the provision of educational services and to administer health and first aid services and/or medical emergency response to students as required. Information is collected under the authority of the s.170, s.190, s.264 and/or s.265 of the Education Act and Sabrina’s Law in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Please refer to the Student Information Practices statement available on the Simcoe County District School Board web site for further information at www.scdsb.on.ca. Questions regarding information collected on this form should be directed to the school principal.

STUDENT INFORMATION COMPUTING TECHNOLOGY APPROPRIATE USE AGREEMENT The Simcoe County District School Board (SCDSB) provides students with a digital media learning environment comprised of information and computing technologies (ICT) which may include: software, Internet access, hardware (computers, printers, scanners, digital cameras, etc.). This procedure sets out standards for appropriate student use of ICT, including board and personally-owned equipment for educational purposes while at school or on school-sponsored activities. Parents/guardians/students acknowledgement and agreement of the appropriate use is required annually. Digital media learning environments use ICT to help students to communicate and work collaboratively, and support individual learning and contribute to the learning of others while gaining skills required to being productive and safe digital citizens. Students use a variety of applications which may include blogs, wikis, learning management systems (such as Moodle, Desire 2 Learn, Edmodo) and social networking sites (such as Facebook, Twitter, YouTube, etc.). When these applications are used as instructional tools, they allow students to:

• interact and publish with peers, experts and others; • communicate information and ideas effectively to multiple audiences; • develop cultural understanding and global awareness by engaging with learners of other cultures; and • contribute to project teams to produce original works or solve problems.

The following safeguards are used to reduce the risk of accessing or viewing inappropriate content online and for student safety. 1. Digital Citizenship - Students receive appropriate instruction on digital citizenship and safe computing practices

based on nine elements of using technology appropriately developed by the International Society for Technology in Education (ISTE). Teachers will review the appropriate use agreement with students at the start of the year/semester and a copy shall be posted in the classroom for reference.

2. Internet Filtering and Blocking - The SCDSB uses appropriate Internet filtering to reduce the risk of students accessing inappropriate content online; however no software is capable of blocking all inappropriate material. Filtering is used on board-owned computers and personally-owned devices connected to the board network.

3. Classroom Supervision – School staff monitor by observation and through online programs to support focussed, purposeful use of ICT when a student is online during the school day.

4. Code of Conduct/Discipline Procedures - The school Code of Conduct (see student agenda) sets out rules for student behaviour including online activity. Inappropriate use is subject to discipline in accordance with the school discipline policy and procedure. Students who are experiencing and/or witness any form of harassing, defaming and/or bullying shall report to a school official.

Appropriate Use • ICT is available for student use to support appropriate instructional practices aligned with curriculum expectations. • Use of ICT shall be in accordance with the laws of Canada and Ontario (e.g. Copyright Act, Criminal Code of Canada,

and the Education Act), Board Policies and Procedures (e.g. Student Discipline Procedures) and the School and Board Code of Conduct.

• ICT use shall be in accordance with safe computing practices. • Students will treat board ICT with respect including reporting known technical, safety or security problems. • Students are responsible for the use of their individual account and shall take all reasonable precautions to prevent

others from being able to access and use their account. The onus is on the student to use ICT appropriately. • When using social networking sites outside of the classroom (i.e. in their homes), students are reminded that

appropriate behaviour and anti-bullying guidelines apply in the online world. Protect your privacy, safety and reputation and the privacy, safety and reputation of others.

FORM A1300 – 1 (Rev October 2013) Page 1 of 2

Inappropriate Use/Activities Students shall not: • attempt to gain unauthorized access (e.g. hacking) into any computer system. • share passwords, except as may be required by staff for maintenance and support purposes. • login to anyone else’s account, or access the personal data of others. • deliberately attempt to disrupt the computer system performance or to destroy data by spreading computer viruses or

by using other means. • share information that, if acted upon, could cause damage or danger of disruption to the system or bring about harm

to others. • engage in cyberbullying. • share private information about another person. • access, store or distribute material that is profane or obscene (including pornography), that advocate illegal or

dangerous acts, or that advocate violence or discrimination towards other people (hate literature). • use ICT to record or photograph other students unless authorized by school teaching or administrative staff prior to

any recordings being made. Such equipment includes board and personally-owned devices, such as cell phones, smart phones, iPods, iPads, computers, personal digital assistants (PDAs), cameras, MP3 players, tape recorders, video-recorders, digital audio recorders and any other technological equipment that allows for recordings to be made of visual images and/or sounds. This is to respect the privacy and ensure the safety of all students and staff.

Students should not expect that online work is private. Staff may access student digital media work spaces for assessment and support purposes, to maintain system integrity and to ensure that students are using the system responsibly and safely. A search may be conducted if there is reasonable cause to suspect that a student has violated the law, the Code of Conduct or this agreement. The decision to allow a student to bring a personally-owned device to school rests with the parent and the student. The board and your child’s school will not be responsible for devices that are lost, stolen or damaged in any manner. Students are responsible for connecting their own devices to the network. Help documents are available, but board staff will not be responsible for connecting student devices. Personal devices are only to be connected to the wireless guest networks and not be plugged into any SCDSB networks using an Ethernet cable. Devices should be easily identifiable, clearly labeled and where possible, registered with the manufacturer. Any violation of this agreement may result in confiscation of personally-owned equipment and appropriate discipline. Confiscated equipment may be returned to the parent/legal guardian or in the event of suspected illegal or inappropriate activity, may be forwarded to the appropriate law enforcement agency. Parents/guardians must recognize that a wide range of materials are available from the Internet, some of which may not be fitting with the particular values of their families.

• I have read the Student ICT Appropriate Use Agreement and understand that I must follow the terms of use outlined

in the agreement. (Computer Use)

• In the event that my child chooses to bring a personally owned device, I understand that the SCDSB and the school accepts no responsibility for the loss, theft, or damage of my/my child’s device and that it will be my/my child’s responsibility to appropriately manage the device at school. (Wireless)

____________________________________ ________________________________ Parent/Guardian/Adult Student Name Parent/Guardian/Adult Student Signature _____________________________ ________________________________ Student Name Student Signature ____________________________ _________________________________ Date School Name FORM A1300 – 1 (Rev October 2013) Page 2 of 2

Photographs and Recording Consent, Waiver and Release

FORM A1450 –4; Rev. December 2009 Page 1 of 1

I hereby grant permission to the Simcoe County District School Board (SCDSB) and its agents or representatives to take photographs, videos or audio recordings of me/my child to promote, publicize or explain the SCDSB and its activities and functions and for administrative or educational or training purposes as outlined below.

Date Event and Location (provide details)

Who is involved (name of individual or class name)

Describe what is being recorded.

Primary Purpose I further grant to the SCDSB and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute and create derivative works of these images and recordings and name in any media now known or later developed. I acknowledge that the SCDSB owns all rights to the images and recordings.

I further grant consent under the Municipal Freedom of Information and Protection of Privacy Act to the SCDSB to collect, use and disclose my image, voice, likeness and name in the video recordings/photographs for the promoting, publicizing or explaining the SCDSB and its activities and for administrative or educational purposes.

Waiver and Release

I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I also waive any right to royalties or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, and hold harmless the SCDSB, its officers, employees or agents from and against any claims, damages or liability arising from or related to the use of the images, recordings or materials.

I have read this document before signing below and I fully understand the contents, meaning and impact of this consent, waiver, and release. This consent, waiver, and release is binding on me, my heirs, executors, administrators and assigns.

I understand that by giving this consent, I am permitting personal information about me or my child to be used as outlined in this form and further understand that if consent were withheld this use would not occur. I have given this consent voluntarily.

Date School

Name of Student (please print) Signature of Student

Name of Parent/Legal Guardian/Adult Student (please print)

Signature of Parent/Legal Guardian/Adult Student

Witness Date Personal information including images and recordings in connection with this form is collected under the authority of the Education Act including s.170,

171, 198, 199, 264 and 265 and in accordance with the Municipal Freedom of Information and Protection of Privacy Act and will be used for promoting, publicizing or explaining the SCDSB and its activities and for administrative, educational or training purposes. Personal information may be disclosed to outside service providers for processing and production. If you have any questions about the collection of personal information please contact the principal of the School or the Freedom of Information/Records Management Officer, 1170 Highway 26, Midhurst, Ontario L4N 7T4, phone (705) 734-6363 ext 11265.

CONSENT TO PARTICIPATE IN MEDIA OR PROMOTIONAL ACTIVITIES

FORM A1450 – 5;Rev. December 2009 Page 1 of 1

(Date)

Dear Parent/Guardian, Adult Student or Adult Participant:

The Simcoe County District School Board and its schools cooperate with media and other organizations, within reason, to encourage the celebration of school achievements, sharing information about students and staff and their work and to report on newsworthy events. For example, an organization may want to: interview you/your child about a newsworthy event; to film/photograph or record digitally you/your child doing an activity; you/your child’s work or accomplishments may be featured or the school may want to enter your child’s work in a contest. We recognize that there are instances where parents may not wish their children to participate in these activities and similarly for students at age of majority and other adults. The notice below provides details regarding the specific activity you/your child are being invited to participate in.

Name of Organization Purpose

Date Event and Location (provide details)

Who is involved (name of individual or class name) Describe what is being recorded.

How will it be used, i.e. newspaper, website, etc.

All or portions of the work referred to above will become the property of the organization and may be adapted for other educational or non-educational applications, productions, broadcast, re-broadcast, publication, exhibition, reproduction and/or distribution in various media formats to a number of markets. CONSENT AND ACKNOWLEDGEMENT I, being the parent/legal guardian of the student named below or adult student/adult, have read and understand the information outlined on this form.

I consent to my/my child’s participation in the activity described above and to the subsequent use as described above.

I do not consent to my/my child’s participation in the activity described above and its subsequent use as described above.

Date School

Name of Student (please print) Signature of Student

Name of Parent/Legal Guardian/Adult Student (please print)

Signature of Parent/Legal Guardian/Adult Student

Witness Date

Personal information is collected under the authority of your signed consent and will be used as outlined above. If you have any questions regarding this collection, or the activity, please contact your school principal or the Freedom of Information/Records Management Officer at (705) 734-6363 ext. 11265.

2014-2015: 015 FORM 1

Elementary and Secondary

MEMORANDUM

To: Student, Parent, or Guardian From: LL Millard-Smith Date: September 2014 Subject: STUDENT ACCIDENT INSURANCE 2014-2015 The Simcoe County District School Board does not provide accident insurance coverage for student injuries that occur on school premises or during school extra-curricular activities (athletics, clubs, field trips), however, accidents can and do happen. Injuries can result in substantial expenses that are not covered by provincial health care or employer group insurance plans. As a student, parent or guardian, you become responsible for these expenses. The Simcoe County District School Board has selected Reliable Life Insurance Company to provide Student Accident Insurance for the 2014-2015 school year. This program offers a variety of plans and benefits at affordable annual prices. Coverage may be purchased any time throughout the year although all policies run from the date of receipt of payment until September 30th 2015. As the cost is very competitive, it remains the same regardless of when it is purchased. The best value for parents exists when purchased in September to enjoy the maximum benefit of coverage. The bronze plan coverage is 24 hour coverage, and is $13.50/year. The platinum plan provides maximum coverage in all areas, including travel, out-of-country medical and surgical benefits for $32.00/year. The cost of the minimum coverage for extra-curricular activities is: $13.50/year.

The cost of the minimum coverage for out-of-province or out-of-country field trips is: $32.00/year. Although Student Accident Insurance is recommended for all students, those students that participate in out-of-province or out-of-country field trips or those students that participate in extra-curricular activities (athletics, clubs) require Student Accident Insurance, Extended Health and Dental coverage from the Board selected provider or another provider (eg. a parent’s benefits plan). The insurance agreement is between the parent and Reliable Life Insurance Company. The Simcoe County District School Board is not compensated in any way by Reliable Life Insurance Company regardless of the number of students participating in the insurance program. Our only interest is to protect our students and their families, resulting in healthier and financially secure communities. Please complete and return the attached acknowledgement form to your child’s school. Sincerely, Principal

Administrative Procedures Memorandum A1420

Page 1 of 2 FORM A1420 – 1

229 Mapleview Drive East Unit 4 Barrie, ON L4N 0W5

STUDENT MEDICAL HEALTH DATA FORM – EFFECTIVE FROM__________TO__________ School ____________________Student Name_____________________________ Date of Birth______________ Legal Guardian (1) _____________________________Relationship to Student ____________________________ Phone: Home ______________________ Bus: ______________________ Cell___________________________ Legal Guardian (2) _____________________________Relationship to Student ____________________________ Phone: Home ______________________ Bus: ______________________ Cell___________________________ Name of Emergency Contact_____________________ Relationship to Student_______________________ Phone: Home ______________________ Bus: ______________________ Cell: __________________________ Is the emergency contact authorized to collect the student from school? Yes No

Medical/Health Data

Student has NO medical or physical condition, which may impede full and safe participation in school

programs or extra-curricular activities. Form completed by: ______________________________________ ________________________________________________ Legal Guardian (please print) Signature _______________________________________________ ______________________________________ ________ Student Name (please print) Signature Date

The Student has medical or physical condition(s) which may require attention during school programs or extra-

curricular activities, The school/legal guardian will prepare a medical emergency plan.

Is the condition life-threatening? Yes No Medical/Physical Condition and Health Factors: (please identify symptoms, conditions or warning signs that indicate that treatment or assistance is required)

Allergies/anaphylaxis: List any life threatening allergic reactions. (e.g., peanuts, bee stings, etc.)

Medications/procedures to follow. Frequency: Treatment/Assistance is usually required: regular/daily occasionally, “as need arises”

Does student reliably: request treatment / assistance when needed? take own medication when needed?

Or is close supervision required to ensure:

need for treatment / assistance? student is taking medication properly (e.g., manner and amount prescribed?)

List any additional emergency procedures this condition may require.

Administrative Procedures Memorandum A1420

Page 2 of 2 FORM A1420 – 1 - 2

ADMINISTRATION OF MEDICATION

Identify any school or extra-curricular activities that the condition makes inappropriate for the student.

Does the student require regular medication for this condition? yes no

If yes, please complete the request for the administration of medication by school personnel section below.

Name/Type of Medication Directions for Storage/Safe Keeping Dosage/Amount to be Given Method of Administration Duration of Administration From To Frequency/Times to be administered Anticipated Reaction to Medication (e.g., symptoms, side effect Reaction to Missed Medication Will student reliably ask for medication if required? Approvals Physician’s Name (please print) Physician’s Signature Date Physician’s Address (please print) Physician’s Telephone Number Student and/or Legal Guardian Authorization I hereby request and give permission for medication to be administered as specified above. This medication, if administered, is administered on a voluntary basis. This request shall expire at the time specified above or at the end of the school year or when the person transfers to another school. This request may be cancelled upon receipt of written notification by the principal of the school in which the student is enrolled. I give consent for school staff to use the information provided in this form to be used to attend to the health and safety of myself/my child. I understand it is my responsibility to make a new request of the receiving principal if my child transfers to another school. Form completed by: ______________________________________ _____________________________ Parent/Legal Guardian (please print) Signature _______________________________________________ ________________________________________________ Student Name (please print) Signature

STATUTORY DECLARATION

Canada

Province of Ontario

To Wit:

In the Matter of

(Name of Student)

I , , (Name of Guardian)

of the of in the (Town / City) (Name of Town / City)

County of (Name of County)

Solemnly Declare, that 1. I, reside at in the town/city of (Street, Concession, P.O. Box) (Name of Town/City)

in the County of Simcoe, Province of Ontario.

2. presently resides with me and is under my care. (Name of Student)

3. I desire to send to (him/her) (Name of School)

for the - school year, and during period as a student there, (Year) (his/her) (he/she)

will be under my sole care and I declare that shall be my responsibility. (he/she)

4. All directions to or concerning should be sent to me at the above (him/her) (him/her)

address as guardian. (his/her)

AND I make this solemn Declaration conscientiously believing it to be true and know that it is of the same

force and effect as if made under oath.

Declared before me in the (Name of Town or City)

in the Municipality of (Name of Municipality)

this day of . (day) (Month & Year) (Signature of Guardian in Canada)

Signed and Sealed by Solicitor or Notary Public (Commissioner)

FORM A7050 – 1a; Rev. 05/03 Page 1 of 2

STATUTORY DECLARATION

(for use by Canadian citizens)

1. The Statutory Declaration issued by the Simcoe County District School Board is a document signed in the presence of a Commissioner* in which an adult assumes a specific relationship between himself/herself and an individual 17 or under named in the document concerning care and place of residence of the individual 17 or under and his/her attendance at school. This declaration is of the same force and affect once made as any other document made under oath.

2. The Statutory Declaration allows a student who would otherwise be unable to qualify as a

pupil of the Board to attend school in Simcoe County without the payment of a fee. 3. Since the document does not establish lawful guardianship between the adult and the student,

the student would not qualify under the resident pupil provision of the Education Act and thus may be charged a fee. However, under the Education Act, a board may admit, at its discretion, a person who would otherwise be denied the right to attend school without the payment of a fee.

4. The person to whom guardianship is granted under the Declaration must be an adult resident

of the county and a Simcoe County ratepayer. The guardian's residence must be assessed to the support of the public school system.

5. Where guardianship is granted to a person who is not a blood relative of the student, a letter is

required from the student's parents stating that they know where their child is and that they approve of the guardian and the arrangements under which their child is living.

6. The parent or student must indicate, in writing, the circumstances as to why he or she cannot

live with his/her parent or lawful guardian.

Acceptable circumstances may include:

(a) the death or disability of one or both parents;

(b) marital separation or divorce in which the custodial parent is temporarily or permanently unable to support the child;

(c) instances of physical or mental abuse in the home following which the student, with

or without the support of one parent, seeks refuge with a relative or friend in Simcoe County;

(d) instances where the parents are required to be out of the province or country for a

temporary period of time and are unable to take the children along. and

(e) situations where the student is attending a program related to the Arts or Sports in Ontario.

A Commissioner is a person empowered to administer oaths and take affidavits.

FORM A7050 – 1b; Rev. 05/03 Page 2 of 2

Simcoe Alternative Secondary School Campus: _________________________

Student Name: ____________________

Start Date: ________________________

Student Schedule

Period Course Teacher If Independent or Credit

Recovery Please Specify

1st

2nd

3rd

FROM the STATUS SHEET

Working Toward OSSD or OSSC?

Total Credit Count

Possible Credits This Term

Plan for next Term?

  Alternative Secondary School   All About Me!                        

My support people are…

 

I learn my best when…

 

I don’t learn well when…

  Alternative Secondary School   All About Me!   

Two things I need from my teachers…

 

Through this program, I hope that…

 

 

I really want you to know that I…