Step 1 of 5 20% The Québec Board of Black Educators Da Costa Hall Summer Institute 2023 program RegistrationPART 2: COURSE SELECTIONThe DaCosta Hall Summer School ProgramWhat high school grade level are you registering courses for?Please choose your grade levelGrade 7Grade 8Grade 9Grade 10Grade 11Grade 7*Grade 7 Math English French Grade 8*Grade 8 Math English French Grade 9*Grade 9 English French Maths Grade 10*Grade 10 English French History Mathematics (CST Option) Mathematics (T & S Option) Mathematics (Science Option) Science & Technology (ST Option) Science & Technology (AST Option) Grade 11*Grade 11 English French Mathematics (CST Option) Mathematics (T & S Option) Mathematics SN (Science Option) Bridge Math Course (From CST to Science) Bridge Science Course (From ST/AST to EST) Physics Admin Registration $ 0.00 CAD CONTACT INFORMATIONStudent InformationWhich Organization referred you?*Please chooseMontreal Community CaresJamaican AssociationZimbabwean AssociationOn our own (O3)Women on the riseSchoolSocial MediaOtherNone of the aboveOther Permanent Code* 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 AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon 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 Select files Accepted file types: doc, docx, pdf, jpg, gif, png, Max. file size: 64 MB. Choose your school board*Choose your School Board-Central Québec School Board-Eastern Shores School Board-Eastern Townships School Board-English Montreal School Board-Lester B. Pearson School Board-New Frontiers School Board-Riverside School Board-Sir Wilfrid Laurier School Board-Western Québec School Board-Private School-Other-Commission Scolaire Marguerite-Bourgeoys-Commission Scolaire de Laval-Commission Scolaire des Laurentides-Commission Scolaire Marie-Victorin-Commission Scolaire de Montréal-Commission Scolaire de la Pointe-de-l'Île-Commission Scolaire de la Seigneurie-des-Mille-Îles- École privées-AutresSchool Cellular NoEmail address* CONTACT INFORMATION CONTINUEDParent Information:Parent* Father Mother Guardian Name* First Name Last Name Address same as student? Yes Address* #civic, street Apartment City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon 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 AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code (if different from the above one)Home Phone*Cellular No.Email address* MEDIA RELEASE CONSENT FORMI 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 SupportChilds Name First Last Parent or Guardian's Name First Last Payment InformationSubtotal $ 0.00 CAD Processing Fee Price: $ 0.00 CAD Total Credit Card Cardholder Name Card Details EmailThis field is for validation purposes and should be left unchanged.