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The Québec Board of Black Educators

BANA Summer Institute 2023 program

Registration

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 some information in order to complete subsequent registrations

Are you registering more than one child for the BANA program?*
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
Disclaimer Kindly note that each center will operate as supported by the number of registrations.
If paying the first week, you will be responsible for paying the following weeks.
BANA Weekly Fee Schedule
BANA Weekly Fee Schedule
Additional note:
BANA Weekly Fee Schedule
Additional note:
Are you interested in daycare services?
Daycare Fees
Daycare Fees
Daycare Fees

CONTACT INFORMATION

Student Information / Information étudiant

Name*
Address*
Gender*
MM slash DD slash YYYY

CONTACT INFORMATION CONTINUED

Parent Information:

Parent*
Name*
Address same as student?
Address*
Add Another Parent/Guardian?
Parent*
Name*
Same address as above?
Address
(if different from the above one)

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
Parent or Guardian's Name

Payment

$ 0.00 CAD
Price: $ 0.00 CAD
$ 0.00 CAD
Credit Card
This field is for validation purposes and should be left unchanged.

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