SUMMER SCHOOL 2015 Reach Ahead New Credit Courses reach Fax to 519-885-0123 Date Sent: ______________ Initials: ______________

Jacob Hespeler S.S., 355 Holiday Inn Dr., Cambridge, Phone: 519-658-4910

Prior to June 29: Phone 519-885-0800 From July 2-July 24: Phone 519-658-4910

To Register Students: Fax REACH AHEAD registration forms to 519-885-0123 by 4:00 p.m. Friday, May 1.

Send White copy of the registration form, continuously, to the Summer School Office at 151 Weber St. S., Waterloo by Monday, May 4, 2014. Provide students with the yellow copy of the registration form.

Please Print

Name:
(Legal Last Name) (Legal First Name) Home Address:
(Apt #., Street #., Street Name) (City) (Postal Code) Home Telephone: ( ) Business Telephone: ( )
Birthdate: 20 (Year) (Month) (Day)	Male: Female:
Home School in June 2015: (If the last school attended is not in Waterloo Region, include address of school)
Secondary School registered for September 2015:
Emergency Contact Name and Phone Number:

To Be Completed By Home School

Student Number: OEN:
Course Code: I am aware of the Summer School policy regarding: Attendance (Course Code)
Are you a Canadian Citizen? Yes No If Canada, Birth Province:______________________________________ If no, check status: Birth Country:________________________________________________ Permanent Resiident Student Visa Entry into Canada: Other Visa Refugee (Year) (Month) Confrimed Proof of Birth: Birth Certificate Immigration papers/Card Passport Other
List health conditions of which the school should be aware: Is Epipen required? Yes No
Signature of Principal or School Designate: School:
Student Signature: Parental/Guardian Signature: (if student is under 18 years of age)

Course Information and Regulations Classes run from July 2 to July 24, from 8:30 a.m. to 3:00 p.m. with a nutrition break. On the first day please report to the school before 8:15 am. Alphabetical lists will be posted in the school foyer for students to determine the course room number. If a student’s name does not show on the alphabetical list the student MUST present a copy of their yellow summer school registration form to enroll in a course. If you have any questions or you decide that you no longer wish to attend summer school, please call 519 885-0800. Please let us know ASAP so we may find a replacement.