BANA Registration

Step 1 of 4

Unique ID
The Québec Board of Black Educators

BANA Summer Institute 2022 program

Registration
PART 2: COURSE SELECTION
BANA Summer Program
Are you registering more than one child for the BANA PROGRAM?
If yes then you will need to register each child individually. After the first registration, you will need to enter in some information in order to complete the second and third registrations
Are you registering more than one child for the BANA program?*
- Yes
- No
Who is this registration for?
Please enter the name of the first child registered.
Which grade level did you last complete?
Select the courses in order of priority that you require the most help*
Scale: 1. Need the most help with 3. Need the least amount of help
English French Math
Please select your preferred location*
- Marymount Academy
- Lasalle Elementary School
Disclaimer Kindly note that each centre will operate as supported by the number of registrations.
BANA Fee Guide*
If paying the first week, you will be responsible for paying the following weeks.
BANA Weekly Fee Schedule
- June 27 - July 1
- July 4 - July 8
- July 11 - July 15
- July 18 - July 22
- July 25 - July 29
- One Time Payment
BANA Weekly Fee Schedule
- June 27 - July 1
- July 4 - July 8
- July 11 - July 15
- July 18 - July 22
- July 25 - July 29
- One Time Payment
Additional note:
BANA Weekly Fee Schedule
- June 27 - July 1
- July 4 - July 8
- July 11 - July 15
- July 18 - July 22
- July 25 - July 29
- One Time Payment
Additional note:
Do you want to apply for a subsidy?
- Yes
- No
Please note applying for a subsidy will delay your registration. You are not guaranteed a spot while we review your application. Please click Here to apply for a subsidy.
Do not complete this application until your subsidy has been approved
I require an alternative fee schedule*
- Yes
- No
If you require a payment schedule
PLEASE DO NOT CONTINUE

To make payment arrangements, please call the program coordinator at 514-481-9400 or email her at sara.oyekanmi@qbbe.ca
Are you interested in the Red Rush Basketball Program?
- Yes
- No
Are you interested in daycare services?
- Yes, I need mornings
- Yes, I need evenings
- Yes, I need both
Daycare Fees
Daycare Fees
- Select All
- One week
- Two weeks
- Three weeks
- Four weeks
- Five weeks
Daycare Fees
- Select All
- One week
- Two weeks
- Three weeks
- Four weeks
- Five weeks
Daycare Fees
- Select All
- One week
- Two weeks
- Three weeks
- Four weeks
- Five weeks

CONTACT INFORMATION
Student Information / Information étudiant
Which Organization referred you?*
Name*
First Name Last Name
Are you a returning student?*
- Yes, from the Fall session
- Yes, from past sessions
- No, I am new
Address*
#civic, street Apartment City Province Postal Code
Date of Birth
MM slash DD slash YYYY
Gender*
- M
- F
Any health conditions or allergies we should be aware of? Please list below.
Documents upload
(including Individual Education Plan (IEP), Report Card, Speech-Language Pathology Test, other relevant assessments)
Drop files here or

Accepted file types: doc, docx, pdf, jpg, gif, png, Max. file size: 64 MB.
Choose your school board*
School
Cellular No
Email address*

CONTACT INFORMATION CONTINUED
Parent Information:
Parent*
- Father
- Mother
- Guardian
Name*
First Name Last Name
Address same as student?
- Yes
Address*
#civic, street Apartment City Province Postal Code
Home Phone*
Cellular No.
Email address*
Add Another Parent/Guardian?
- Yes
Parent*
- Father
- Mother
- Guardian
Name*
First Name Last Name
Same address as above?
- Yes
Address
#civic, street / #civique, rue Apartment City Province Postal Code

(if different from the above one)
Home Phone*
Cellular No.
Email address*
Hidden
Please select your method of payment
Subtotal
$ 0.00 CAD
Processing Fee
Price: $ 0.00 CAD
Total
$ 0.00 CAD

MEDIA RELEASE CONSENT FORM
I hereby give the Quebec Board of Black Educators (QBBE) the right and permission to record my image or likeness while I participate in the Project/Event identified below. Furthermore, I hereby irrevocably give QBBE the right and permission to use my image or likeness so recorded.

QBBE’s right of use shall include the right to publish, adapt, exhibit, reproduce, edit, distribute and display my image or likeness in connection with any product or service for any purpose (including marketing, promotion advertising and trade) in all markets, media or technology now known or hereafter developed.

For certainty, and without limiting the above, QBBE’s right of use shall also allow it to publish my image or likeness on the internet, incorporate my image or likeness into promotional videos and share my image or likeness with media organizations for any purpose.

I shall not have any entitlement to compensation for QBBE’s recording and use and shall not make any claim against QBBE, its affiliates, agents, event partners, governors, officers and/or employees for damages that may arise from its recording or use including, without limitation, any claim that is based on an alleged misrepresentation, negligence, defamation, breach of privacy, right of publicity infringement or an infringement of any applicable privacy legislation.

By signing my name, I acknowledge that I have read, understand and agree with the contents contained within this Consent and Release.

If under 18 years of age, a signature of a parent or guardian is required. I acknowledge that I have read and understood this Consent and Release. I agree to its terms in connection with the photographic or electronic records of the likeness of my child:

Select the platforms you wish to give permission for use:
- I grant QBBE permission to use my image or likeness on QBBE’s Website
- I grant QBBE permission to use my image or likeness on the QBBE Newsletter & Official Reports
- I grant QBBE permission to use my image or likeness on the QBBE Facebook page
- I grant QBBE permission to use my image or likeness on the QBBE Instagram page
Project/Event: Fall 2021 Academic Support
Childs Name
First Last
Parent or Guardian's Name
First Last
Name
This field is for validation purposes and should be left unchanged.

English	French	Math

Step 1 of 4

The Québec Board of Black Educators

PART 2: COURSE SELECTION

BANA Summer Program

CONTACT INFORMATION

Student Information / Information étudiant

CONTACT INFORMATION CONTINUED

Parent Information:

MEDIA RELEASE CONSENT FORM