Year Month Day

Under Canada’s Anti-Spam law (CASL) the Dufferin-Peel Catholic District School Board requires your consent to send you electronic messages about commercial activities. While much of our email communication is about school, school council or Board news and activities, we may also send electronic messages of a commercial nature. This would include newsletters and other communications about such things as field trips, yearbooks, uniforms, school pictures, fundraising activities and events, food and drink purchases, books, prom or dance tickets, sporting/athletic events or similar events and offers.

If you wish to receive the above electronic communications from us, please provide your email address below. Your consent remains in effect as long as the student attends a DPCDSB school unless you withdraw it. If you have any questions, or wish to revoke your consent at any time please contact your school principal.

Signature of Parent/Guardian: Email Address:

SIGNATURES

PLEASE NOTE: Falsifying information on this form may rescind the admission to this elementary school

Signature of Parent/Guardian: Date:

Signature of Principal/Designate: Date:

Student Registration and Information Form - Elementary School

Legal Names: (Students are registered by their legal name which will be used on legal documents. The student’s preferred name will be used at school.)

Surname: First Name: Middle Name:

Preferred Names: Same as Legal Names, or

Surname: First Name: Middle Name:

Gender: Female Male Birthdate:

Previous school attended: First day of entry to any school in Ontario:

Previous School Board: ________________________________

If the student is entering from outside of Ontario, please indicate name of

Does this student have sibling(s) in this District School Board? Yes No If yes: Elementary Secondary

If yes, provide full name(s):

Does this student have sibling(s) in another District School Board? Yes No

If yes, state name of District School Board:

This student is the: only eldest youngest in their family, at this school

Is this student Roman Catholic, or, in an Eastern Church in full communion with the Holy See of Rome? Yes No Note: Students/Parents/Guardians registering at St. Sofia School must be baptized in the Byzantine Rite of the Roman Catholic Church

If yes, provide an original Roman Catholic Baptismal Certificate. If no, receive Sacramental Preparation Letter from school

If yes: Date of Baptism: Church and City:

If no, specify who is Catholic*: Mother Father Legal Guardian

*Note: An original Roman Catholic Baptismal Certificate of one of the parents/guardians must be provided at the time of registration of the student.

Medical Condition(s)/Alert:

Custody Information

Who has legal custody? Both parents Father only Mother only Other

Are there any special arrangements pertaining to access/visitation? Yes No

If yes, then the most recent original Court Order to support custody must be provided (a verified copy to be stored in the OSR)

CANADA’S ANTI-SPAM LAW CONSENT

STUDENT PERSONAL INFORMATION PART 1

Personal information collected shall be used to establish and/or maintain the student’s Ontario Student Record (OSR) for the provision of educational services and to administer health and/or medical emergency responses to the student as required. In keeping with the requirements of the Education Act, the OSR and other information required to establish an appropriate program for the student shall be requested from the student’s former school.

Information is collected under the authority of the Education Act, R.S.O. 1990, c. E.2, (s.170, s.190, s.264, s.265); Sabrina's Law, 2005, S.O. 2005, c. 7 and Ryan’s Law (Ensuring Asthma Friendly Schools), 2015, S.O. 2015, C. 3 in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Any questions regarding information collected, may be directed to the school principal or to the Records Management and Access & Privacy Administrator, 40 Matheson Blvd West, Mississauga, ON L5R 1C5 (905) 890-1221 ext. 24443

Office use only

School: Lester B Pearson Catholic School_ Grade: _____ Teacher: ______________ Start date:_____________

Documents to be filed in the OSR: Newcomer Reception Report P.E.D.S. (Personal Electronic Device) Agreement Application for Direction of School Support/Lease IPRC Documentation Baptismal Certificate of Student IEP Documentation Baptismal Certificate of Parent/Guardian (if applicable) Medication Forms Confirmation of Pupil Eligibility (GF008.1) Flex Boundary Documentation Registration form Network User Agreement Copy of most recent Custody Order if applicable (original document to be viewed and verified)

Original documents to be viewed and verified but not filed in the OSR

Birth Certificate Citizenship/Immigration/Intl. Student Verification Immunization Certificate or Statement of Medical Exemption (copy only sent to Peel Health) Proof of Residence Source: ___________________________________

(e.g., property tax bill, current utility bill, real estate document, or Government of Canada issued forms)

Office Signature_______________________________________

The Mission of the Dufferin-Peel Catholic District School Board, in partnership with the family and church, is to provide, in a responsible manner, a Catholic education which develops spiritual, intellectual, aesthetic, emotional, social, and physical capabilities of each individual to live fully today and to meet the challenges of the future, thus

enriching the community.

Year Month Day

Page 1

Year Month Day

Territory/Province/Country

Page 4 GF 008 E

Revised Oct 15 GF 008 E

Revised Oct 15CC: Copy to be filed in the OSR

Number Street Unit Type (e.g. Apt.) Unit #

Year Month Day Year Month Day

STUDENT PERSONAL INFORMATION PART 2

Student’s Country of Birth: If Canada, Province of Birth:

Arrival Date (into Canada): Expiry Date (if applicable):

If arrived within the past five years, complete the ‘Confirmation of Pupil Eligibility . . .’ form (GF008.1).

Status in Canada: (√ one) ☐ Canadian Citizen ☐ Permanent Resident ☐ Refugee ☐ Permanent Resident Pending ☐ Temporary Resident ☐ Parent on Work Permit☐ International Student ☐ Parent on Study Permit ☐ Student on Study Permit

Country of Last Residence: Country of Citizenship:

Note: If new to Ontario, please provide the school with a copy of the student’s most recent Report Card.

ABORIGINAL STUDENT (Voluntary Self-Identification): For the purposes of supporting First Nation, Métis and Inuit student achievement objectives of Dufferin-Peel and the Ministry of Education, and of reporting student achievement to the Ministry of Education and the Education Quality and Accountability Office, I / we choose to voluntarily self-identify my/this child’s ancestry as:

First Nations Inuit Métis First Nation Métis and Inuit Ancestry

STUDENT ADDRESS

( ) City Postal Code Phone #

Mailing Address (if different from above): Proof of Residence Source: ___________________________________________________

(e.g., property tax bill, current utility bill, real estate document, or Government of Canada issued forms)

Please indicate if this student: lives in a group home Yes No Is enrolled in a Care, Treatment, Custody, Corrections (CTCC) program? Yes No

PARENTAL/GUARDIAN CONTACT INFORMATION

Emergency Priority (Circle one): 1 2 3 4 Speaks English

Title First Name Last Name Relationship to Student

Address: Same as student or

Home Phone: Same as student or Business Phone

Cell Phone: Alternate Phone:

Emergency Priority (Circle one): 1 2 3 4 Speaks English

Title First Name Last Name Relationship to Student

Address: Same as student or

Home Phone: Same as student or Business Phone:

Cell Phone: Alternate Phone:

Caregiver Contact: (Complete this section if child care is provided at a different address from the student’s.)

Address:

Phone: Alternate Phone:

Emergency Contact (other than parent/guardian/caregiver):

Emergency Priority (Circle one): 1 2 3 4 Speaks English

Title First Name Last Name Relationship to Student

Address: Same as student or

Home Phone: Same as student or Business Phone:

Cell Phone:

ADDITIONAL INFORMATION

Language(s) spoken by student:

First Language Spoken at Home Remark:

First Language Spoken at Home Remark:

Special Education:

Does student have special education/diverse learning needs? Yes No

Does student have specialized equipment? Yes No SEA Yes No

In your previous school/board, was this student involved in special education programs and/or services? Yes No

Does this student have an Individual Education Plan (IEP)? Yes No

Has this student been identified as an exceptional student, through the Identification Placement Review Committee (IPRC)? Yes No If yes, date of most recent IPRC review, as appropriate: __________________________________

Is the student’s transition plan attached to the IEP? Yes No

English Language Learners (ELL)

In your previous school/board, did this student receive ESL/ELD services? Yes No

SAFE SCHOOLS

Suspension/Expulsion

1. Is the student being registered currently serving a suspension? Yes No2. Is the student being registered currently participating in a program for suspended students? Yes No3. Is the student being registered expelled from any school and, if yes, have they successfully

completed a program for expelled students? ____________________________________ Yes No

( )

( )

( ) Ext.

Separate School Supporter: Yes No

( )

Gender: Female Male Speaks English

Gender: Female Male

Or Name of Caregiver Title First Name Last Name

Caregiver Relationship to Student

( ) ( )

( )

( )

( ) Ext.

Emergency Priority (Circle one): 1 2 3 4

GF 008 E Revised Oct 15

Page 2 Page 3 GF 008 E Revised Oct 15

Separate School Supporter: Yes No

( )

( )

( ) Ext.

Ext. ( )

Number Street Unit Type (e.g. Apt.) Unit #

Year Month Day Year Month Day

STUDENT PERSONAL INFORMATION PART 2

Student’s Country of Birth: If Canada, Province of Birth:

Arrival Date (into Canada): Expiry Date (if applicable):

If arrived within the past five years, complete the ‘Confirmation of Pupil Eligibility . . .’ form (GF008.1).

Status in Canada: (√ one) ☐ Canadian Citizen ☐ Permanent Resident ☐ Refugee ☐ Permanent Resident Pending ☐ Temporary Resident ☐ Parent on Work Permit☐ International Student ☐ Parent on Study Permit ☐ Student on Study Permit

Country of Last Residence: Country of Citizenship:

Note: If new to Ontario, please provide the school with a copy of the student’s most recent Report Card.

ABORIGINAL STUDENT (Voluntary Self-Identification): For the purposes of supporting First Nation, Métis and Inuit student achievement objectives of Dufferin-Peel and the Ministry of Education, and of reporting student achievement to the Ministry of Education and the Education Quality and Accountability Office, I / we choose to voluntarily self-identify my/this child’s ancestry as:

First Nations Inuit Métis First Nation Métis and Inuit Ancestry

STUDENT ADDRESS

( ) City Postal Code Phone #

Mailing Address (if different from above): Proof of Residence Source: ___________________________________________________

(e.g., property tax bill, current utility bill, real estate document, or Government of Canada issued forms)

Please indicate if this student: lives in a group home Yes No Is enrolled in a Care, Treatment, Custody, Corrections (CTCC) program? Yes No

PARENTAL/GUARDIAN CONTACT INFORMATION

Emergency Priority (Circle one): 1 2 3 4 Speaks English

Title First Name Last Name Relationship to Student

Address: Same as student or

Home Phone: Same as student or Business Phone

Cell Phone: Alternate Phone:

Emergency Priority (Circle one): 1 2 3 4 Speaks English

Title First Name Last Name Relationship to Student

Address: Same as student or

Home Phone: Same as student or Business Phone:

Cell Phone: Alternate Phone:

Caregiver Contact: (Complete this section if child care is provided at a different address from the student’s.)

Address:

Phone: Alternate Phone:

Emergency Contact (other than parent/guardian/caregiver):

Emergency Priority (Circle one): 1 2 3 4 Speaks English

Title First Name Last Name Relationship to Student

Address: Same as student or

Home Phone: Same as student or Business Phone:

Cell Phone:

ADDITIONAL INFORMATION

Language(s) spoken by student:

First Language Spoken at Home Remark:

First Language Spoken at Home Remark:

Special Education:

Does student have special education/diverse learning needs? Yes No

Does student have specialized equipment? Yes No SEA Yes No

In your previous school/board, was this student involved in special education programs and/or services? Yes No

Does this student have an Individual Education Plan (IEP)? Yes No

Has this student been identified as an exceptional student, through the Identification Placement Review Committee (IPRC)? Yes No If yes, date of most recent IPRC review, as appropriate: __________________________________

Is the student’s transition plan attached to the IEP? Yes No

English Language Learners (ELL)

In your previous school/board, did this student receive ESL/ELD services? Yes No

SAFE SCHOOLS

Suspension/Expulsion

1. Is the student being registered currently serving a suspension? Yes No2. Is the student being registered currently participating in a program for suspended students? Yes No3. Is the student being registered expelled from any school and, if yes, have they successfully

completed a program for expelled students? ____________________________________ Yes No

( )

( )

( ) Ext.

Separate School Supporter: Yes No

( )

Gender: Female Male Speaks English

Gender: Female Male

Or Name of Caregiver Title First Name Last Name

Caregiver Relationship to Student

( ) ( )

( )

( )

( ) Ext.

Emergency Priority (Circle one): 1 2 3 4

GF 008 E Revised Oct 15

Page 2 Page 3 GF 008 E Revised Oct 15

Separate School Supporter: Yes No

( )

( )

( ) Ext.

Ext. ( )

Year Month Day

Under Canada’s Anti-Spam law (CASL) the Dufferin-Peel Catholic District School Board requires your consent to send you electronic messages about commercial activities. While much of our email communication is about school, school council or Board news and activities, we may also send electronic messages of a commercial nature. This would include newsletters and other communications about such things as field trips, yearbooks, uniforms, school pictures, fundraising activities and events, food and drink purchases, books, prom or dance tickets, sporting/athletic events or similar events and offers.

If you wish to receive the above electronic communications from us, please provide your email address below. Your consent remains in effect as long as the student attends a DPCDSB school unless you withdraw it. If you have any questions, or wish to revoke your consent at any time please contact your school principal.

Signature of Parent/Guardian: Email Address:

SIGNATURES

PLEASE NOTE: Falsifying information on this form may rescind the admission to this elementary school

Signature of Parent/Guardian: Date:

Signature of Principal/Designate: Date:

Student Registration and Information Form - Elementary School

Legal Names: (Students are registered by their legal name which will be used on legal documents. The student’s preferred name will be used at school.)

Surname: First Name: Middle Name:

Preferred Names: Same as Legal Names, or

Surname: First Name: Middle Name:

Gender: Female Male Birthdate:

Previous school attended: First day of entry to any school in Ontario:

Previous School Board: ________________________________

If the student is entering from outside of Ontario, please indicate name of

Does this student have sibling(s) in this District School Board? Yes No If yes: Elementary Secondary

If yes, provide full name(s):

Does this student have sibling(s) in another District School Board? Yes No

If yes, state name of District School Board:

This student is the: only eldest youngest in their family, at this school

Is this student Roman Catholic, or, in an Eastern Church in full communion with the Holy See of Rome? Yes No Note: Students/Parents/Guardians registering at St. Sofia School must be baptized in the Byzantine Rite of the Roman Catholic Church

If yes, provide an original Roman Catholic Baptismal Certificate. If no, receive Sacramental Preparation Letter from school

If yes: Date of Baptism: Church and City:

If no, specify who is Catholic*: Mother Father Legal Guardian

*Note: An original Roman Catholic Baptismal Certificate of one of the parents/guardians must be provided at the time of registration of the student.

Medical Condition(s)/Alert:

Custody Information

Who has legal custody? Both parents Father only Mother only Other

Are there any special arrangements pertaining to access/visitation? Yes No

If yes, then the most recent original Court Order to support custody must be provided (a verified copy to be stored in the OSR)

CANADA’S ANTI-SPAM LAW CONSENT

STUDENT PERSONAL INFORMATION PART 1

Personal information collected shall be used to establish and/or maintain the student’s Ontario Student Record (OSR) for the provision of educational services and to administer health and/or medical emergency responses to the student as required. In keeping with the requirements of the Education Act, the OSR and other information required to establish an appropriate program for the student shall be requested from the student’s former school.

Information is collected under the authority of the Education Act, R.S.O. 1990, c. E.2, (s.170, s.190, s.264, s.265); Sabrina's Law, 2005, S.O. 2005, c. 7 and Ryan’s Law (Ensuring Asthma Friendly Schools), 2015, S.O. 2015, C. 3 in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Any questions regarding information collected, may be directed to the school principal or to the Records Management and Access & Privacy Administrator, 40 Matheson Blvd West, Mississauga, ON L5R 1C5 (905) 890-1221 ext. 24443

Office use only

School: Lester B Pearson Catholic School_ Grade: _____ Teacher: ______________ Start date:_____________

Documents to be filed in the OSR: Newcomer Reception Report P.E.D.S. (Personal Electronic Device) Agreement Application for Direction of School Support/Lease IPRC Documentation Baptismal Certificate of Student IEP Documentation Baptismal Certificate of Parent/Guardian (if applicable) Medication Forms Confirmation of Pupil Eligibility (GF008.1) Flex Boundary Documentation Registration form Network User Agreement Copy of most recent Custody Order if applicable (original document to be viewed and verified)

Original documents to be viewed and verified but not filed in the OSR

Birth Certificate Citizenship/Immigration/Intl. Student Verification Immunization Certificate or Statement of Medical Exemption (copy only sent to Peel Health) Proof of Residence Source: ___________________________________

(e.g., property tax bill, current utility bill, real estate document, or Government of Canada issued forms)

Office Signature_______________________________________

The Mission of the Dufferin-Peel Catholic District School Board, in partnership with the family and church, is to provide, in a responsible manner, a Catholic education which develops spiritual, intellectual, aesthetic, emotional, social, and physical capabilities of each individual to live fully today and to meet the challenges of the future, thus

enriching the community.

Year Month Day

Page 1

Year Month Day

Territory/Province/Country

Page 4 GF 008 E

Revised Oct 15 GF 008 E

Revised Oct 15CC: Copy to be filed in the OSR

(November 2012)

GF 066

NETWORK USER APPLICATION AND AGREEMENT

TO BE COMPLETED ON FIRST REGISTRATION IN DUFFERIN-PEEL The Dufferin-Peel Catholic District School Board policy supports the use of the local and wide area networks for electronic communication, and the Board believes this to be an integral part of the school curriculum. In addition to the school’s Catholic Code of Conduct and to outline in some detail the responsibilities of the school and the Dufferin-Peel Catholic District School Board, any student using the school network is required to adhere to the following rules: 1. These are the “Rules of Conduct” for Electronic Networks in Dufferin-Peel schools,

including internet access. 2. The school reserves the right to change the rules at any time without notifying users.

(Changes to rules will be posted.) 3. The school reserves the right to remove network access from any user who breaks

these rules. 4. The school does not warrant that the functions will meet any specific requirements

the student may have; nor that it will be error free or uninterrupted; nor shall it be liable for any indirect, incidental, or consequent damages (including lost data, information or profits) sustained or incurred in connection with the use of, operation of, or inability to use the system. The student maintains responsibility for meeting al personal deadlines regardless of network availability.

5. The student is responsible for his/her actions while using the computer. 6. The student will not assist in breaking these rules or be a party to others breaking

these rules. 7. The student must not intentionally seek information, browse, obtain copies, modify

files, or passwords belonging to others, whether at the school or elsewhere, unless specifically authorized to do so by those individuals.

8. Consistent with item 7, the student will refrain from using or introducing to the

school computer environment, whether network or stand-along, files, programs, or disks known to contain viruses. In this spirit, the student will also regularly check his/her files and disks for viruses and endeavour to keep computing systems virus free.

9. The student must not try to obtain system privileges to which he/she is not entitled. 10. The student will not share his/her login and password with others, nor attempt to

learn or use logins and passwords which are not his/her own.

Network User Application and Agreement - 2 -

11. The student must not exploit any gaps in security and, furthermore, must report

these gaps immediately to his/her teacher. 12. The student must not seek or send images, sounds, or messages which might be

considered inappropriate, obscene, abusive, offensive, harassing, illegal, or counsel to illegal activities.

13. A student who receives or encounters any of the material indicated in item 12, which

makes him/her feel uncomfortable, should report it to his/her teacher immediately. 14. The student is responsible for determining the copyright status of any program(s) or

data used, and for respecting intellectual property rights and the laws which govern them.

15. It is the student’s responsibility to back-up, save, and maintain any of his/her

information. 16. The student must abide by all federal, provincial and local laws. 17. The school reserves the right to review, edit or remove any material stored on Board

computer/network facilities. 18. The school will be the arbiter of what constitutes a violation of this Agreement. School: ________________________________________________________________________________________________ Name of Student (Please print): ____________________________________________________________________ I acknowledge that I have received and will abide by the Network User Application and Agreement and that this Agreement remains in effect for the duration of the student’s tenure in this school system. Signature of Student: _______________________________________________________________________________ Signature of Parent/Guardian: _____________________________________________________________________ Date: ________________________________________

ANNUAL CONSENT AND NOTIFICATION FORM - ELEMENTARY GF 068

Student Name School

Parent/Guardian Name (please print) Grade/Teacher

Student Agenda/Handbook

The student handbook/agenda contains information for students and parents about school policies, guidelines and expectations for students. Please read and review the school handbook/agenda with your child. If you have not received a copy of the student handbook/agenda, please contact your classroom teacher.

In addition, please indicate your wishes below regarding: • use and disclosure of student work, pictures and recordings on the internet/social media, to media and within the

school community;• permission for walking excursions to local sites; and• lunch hour permissions.

Use and Disclosure of Student Pictures, Recordings and Work

The attached document titled, Notification of the Collection, Use and Disclosure Of Student Personal Information for the Purpose Collected or for a Consistent Purpose – Elementary and Secondary, outlines how the Dufferin-Peel Catholic District School Board routinely uses student information we collect, as authorized by the Education Act and the Municipal Freedom of Information and Protection of Privacy Act. Please review it and address any questions you may have to the school principal.

In addition, we would like to celebrate and showcase student achievements and activities and are seeking your consent to share personal information about your child including: student work, name and/or identifying images and/or recordings. Achievements and activities may include: student work/projects, plays, athletics, extra-curricular activities, presentations, awards, ceremonies and field trips.

With appropriate consent, information may be shared: • on school and/or board websites, social media sites (such as Twitter, Facebook, YouTube, school blogs) school and

board newsletters;• within the school and/or church community; and• with local and/or national media for reporting newsworthy events.

☐ Yes, I consent to use of my child’s work, name andidentifying images and/or recordings as outlined above. Iunderstand that I may withdraw consent at any time withwritten notice to the principal; however that it may not bepossible to remove or recall information previously shared. Parent/Guardian Signature

☐ No, I do not consent to my child’s work, name and identifying images and/or recordings as outlined above.

Parent/Guardian Student Signature

(Revised: September 2016) Please return completed form to the school.

Lester B. Pearson Catholic Elementary School

ANNUAL CONSENT AND NOTIFICATION FORM - ELEMENTARY GF 068

Student Name School

Parent/Guardian Name (please print) Grade/Teacher

Permission for Walking Excursions to Local Sites

Throughout the school year, students may go on supervised walking excursions in the school neighbourhood, for example: to church, local park, etc. These walking excursions may be spontaneous activities that are dependent on weather conditions and do not generally require special provisions for transportation, lunch or fees. Staff will discuss safety procedures prior to the excursion. Please advise the staff of any special considerations.

☐ Yes, my child may participate in local walking excursions asdetermined by the school.

Parent/Guardian Signature ☐ No, my child may not participate in local walking excursions

as determined by the school.Parent/Guardian Signature

Lunch Hour Permissions

Students who remain at school for lunch are not permitted to leave school property during the lunch hour. Written permission or a phone call from a parent/guardian is required to permit a student to leave school property during lunch. Students who normally remain at school for lunch and leave school property without appropriate permission, may face consequences and outlined in the Catholic Code of Conduct. I understand that I must provide written permission to change these arrangements.

My child will leave the school for lunch every day. Parent/Guardian Signature

My child will remain at school for lunch every day. Parent/Guardian Signature

(Revised: September 2016.) Please return completed form to the school.

Lester B. Pearson Catholic Elementary School

GF 401

ELEMENTARY HEALTH AND PHYSICAL EDUCATION CURRICULUM – MEDICAL INFORMATION/ELEMENT OF RISK

This form is to be completed for all students and returned to the classroom teacher.

Dear Parent(s)/Guardian(s):

Vigorous physical activity is essential for normal, healthy growth and development. Growing bones and muscles require not only good nutrition, but also the stimulation of vigorous physical activity to increase the strength and skills necessary for a physically active lifestyle. Active participation provides opportunities for students to discover and trust themselves and gain the confidence necessary to play and work cooperatively and competitively with their peers. The physical education curriculum provides opportunities for students to experience the fitness feeling and to help them understand and make decisions regarding personal fitness and the value of physical activity in their daily lives.

It is important that your child participate safely and comfortably in the physical education program. The Dufferin-Peel Catholic District School Board adheres to the Ontario Physical and Health Education Association (OPHEA) Guidelines. In your child’s best interests, we recommend the following: a) An annual medical examination; b) Appropriate attire for safe participation (T-shirt, shorts or track pants and running shoes). Hanging

jewelry must not be worn; c) The wearing of an eyeglass band and/or shatterproof lens if your child wears glasses which cannot be

removed during physical education classes; d) The wearing of sun protection for all outdoor activities; e) Safety inspection at home of any equipment brought to school for personal use in class.

___________________ _______________ __________________________________ (Name of Student) (Grade) (Teacher)

I would like to inform the school about these facts pertaining to my son/daughter’s physical/medical condition related to his/her participation in the Health and Physical Education Curriculum. 1. What medication(s) should your son/daughter have on hand during health and physical education class? _________ 2. Does your son/daughter wear a medical alert bracelet ____ neck chain _____ or carry a medical alert card? ________ If yes, please specify what is written on it: _____________________________________________________________ 3. Any other relevant medical condition that will require modification of the program: ___________________________ ________________________________________________________________________________________________

4. Should your son/daughter sustain an injury or contact an illness requiring medical attention during the school

year, notify the classroom teacher and complete the “Request to Resume Athletic Participation Form”, as applicable.

If during the school year your son/daughter’s medical information profile changes, please notify the school.

(Revised April 2013)

ELEMENTS OF RISK: Educational activity programs, such as sporting events or activities, field trips and other activities, may present various elements of risk. Incidents related to such activities may occur and cause injury through no fault of the school board or the facility at which the activity or event is being held. Participants must assume these risks. The following class activities including and not limited to are identified as having the potential for more serious consequences are: alpine skiing/snowboarding, broomball (ice), cheerleading(acrobatic), field hockey, field lacrosse, gymnastics, ice hockey, ringette (ice), swimming, wrestling, and/or field events: high jump, shot put. The safety and well-being of students is a prime concern and attempts are made to manage, as effectively as possible, the foreseeable risks inherent in physical activity. Please contact the school to discuss any sport specific safety concerns. Various health/physical education activities may take students into the immediate community to participate; e.g., in-class cross country running, orienteering, soccer, softball, etc., at nearby community parks.

□ I acknowledge the element of risk information noted above for the Health and Physical Education Curriculum. Parent/Guardian Signature: Date: _____________ NOTE TO STUDENT/PARENT(S)/GUARDIAN(S): The Dufferin-Peel Catholic District School Board does not provide any accidental death, disability, dismemberment or medical expenses’ insurance on behalf of students participating in these activities. The Dufferin-Peel Catholic District School Board distributes Student Accident Insurance to the Parent/Guardian/Student, annually.

□ I acknowledge that the Dufferin-Peel Catholic District School Board does not provide accident or life insurance for students.

□ I acknowledge that I have received a copy of the student accident insurance brochure.

__________________________ __________ ___________________________ _________ (Signature of Student) (Date) (Signature of Parent/Guardian) (Date)

Distribution to: ____Parent/Guardian ____Classroom Teacher MUNICIPAL FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT: Personal information on this form is collected under the legal authority of the Education Act, R.S.O. 1990, c.E.2., as amended. This information will be used for purposes of planning and administering Physical Education programs for students and providing health and safety services in the event of an emergency. Questions regarding the collection of personal information are to be directed to the School Principal.

NOTIFICATION OF THE COLLECTION, USE AND DISCLOSURE

OF STUDENT PERSONAL INFORMATION FOR THE PURPOSE COLLECTED

OR FOR A CONSISTENT PURPOSE - ELEMENTARY AND SECONDARY

GF 067

The Dufferin-Peel Catholic District School Board (DPCDSB) wants to help you understand how we use personal information that we

collect about your child in keeping with our legislated duties under the Education Act and the Municipal Freedom of Information and

Protection of Privacy Act (MFIPPA).

The Education Act requires that school boards promote student achievement and well-being and deliver effective and appropriate

educational programs for students. Schools collect and use student personal information to fulfill their legislated duties. The

school principal is required to establish and maintain an Ontario Student Record (OSR) for each student attending school in

accordance with the Ontario Student Records Guideline and Board Policy. The OSR is a cumulative record of the student’s progress

used by staff to support student achievement and well-being that follows the student through Ontario elementary and secondary

schools.

The Municipal Freedom of Information and Protection of Privacy Act sets guidelines for schools/boards to follow when collecting,

using and/or disclosing students’ personal information. Under this law, personal information refers to recorded information about

an identifiable individual and may be used or disclosed:

• for the purpose for which it was obtained or a purpose consistent with the reason collected;

• to board officers or employees who need access to the information in the performance of their duties, if necessary and required

for the discharge of the board’s duties;

• to comply with laws, a court order or subpoena to aid in a law enforcement by a law enforcement agency; or

• to report to the Children’s Aid Society regarding child protection matters in compelling circumstances affecting health or safety

of staff or students in accordance with the law.

EXAMPLES OF ROUTINE USES OF STUDENT PERSONAL INFORMATION

Student Instruction, Achievement and Well-Being

· Student personal information, including OSR information, will be used by school and board staff for the purpose of meeting

student’s needs, promoting student achievement and well-being and to support the transition of students between schools and

programs (elementary to secondary school, French Immersion programs, etc.). Staff may include teachers of the student,

guidance counsellors, student success teachers, educational resource workers, special education teachers and administrators.

· Information about the student’s progress at secondary school may be shared with their former elementary school to support the

continuous improvement of the elementary school program to benefit all students.

· Students may be photographed or recorded as part of teaching and learning to support student achievement and assessment.

· Student work, including student name, may be displayed throughout the school and in school and Board newsletters. It may

also be displayed at community events such as science fairs, colouring/writing/poster contests or similar events outside the

school.

· Contact information, marks and transcripts are shared with Ontario colleges and universities to support post-secondary

applications.

· Referrals to personal health services such as psychological assessments, speech and language assessments, social work and

child and youth service require the consent of the parent/guardian/adult student. On referral, you will be advised how personal

health information is collected and used.

· Ancestry information of self-identified First Nation, Métis and Inuit students, will be used to allocate resources, improve student

learning and student success and reported to the Ministry of Education and the Education Quality Accountability Office (EQAO).

Health and Safety/Transportation

· Student medical health information provided by parents/guardians or adult students will be used to address the student’s

medical needs at school and during school activities.

· Personal information is shared with the Regional Public Health Units in accordance with the Education Act the Immunization of

School Pupils Act. Communicable diseases shall be reported in accordance with the Health Promotion and Protection Act and

the Education Act.

· Surveillance equipment may be used on school property to enhance the safety of students and staff, to protect property against

theft or vandalism and to aid in the identification of intruders or persons who endanger the health, well-being or safety of

school community members.

· Student accidents will be reported to the board’s insurer. Reports include the name of the injured student(s) and details about

the incident, as well as the name and contact information of witnesses to the accident.

Notification of the Collection and Use and Disclosure

of Student Personal Information - Page 2

School Events and Activities

· Personal information including student name, number and date of birth are shared with the Board’s online payment system

provider so parents may remit student activity and other fees online.

· Personal information such as student name, date of birth, year of entry into grade 9 and credits achieved, shall be shared with

Board-approved Governing Athletic Associations for the purpose of determining eligibility requirements to participate in

inter-school competitive programs.

· Student names and/or photographs may be printed in school yearbooks, school programs or brochures (i.e. graduation

programs, celebration of sacraments, school plays and musical productions), on student awards, honour roll, class assignment

lists and posted throughout the school.

· School newsletters report on school events and activities. They may include limited student personal information such as

student name and student photos. Consent is sought to share personal information and/or photos on the internet or on social

media.

· On occasion, the media may be invited to schools and board sites to report on school/board events or activities. Students may

be photographed/recorded as part of a group, but only those students with appropriate consents will be interviewed and

identified.

· Contracted photographers will take individual and class photos of students. These photos will be used for administrative and

archival purposes, on student cards, in school yearbooks and will be offered to parents for purchase.

· Birthdays may be celebrated at school. Class lists with student first names and last initial may be distributed for the purpose of

addressing greeting cards or invitations in connection with holidays, birthday parties, etc.

· Authorized volunteers or school council members may contact parents on behalf of the school regarding school-related

activities which benefit the student and the school community or for the safe arrival/attendance verification program.

Community or Public Events

· We understand that parents, family members or friends may want to take photos/videos at school events or activities where the

public is invited. Visitors are asked to follow the direction of the principal at these events as in some cases, photos or

recordings may not be allowed. Where photography or recording is permitted, visitors should always try to capture

photos/videos of only their own child. Where photos/videos include other students or staff, please respect the digital footprint

and privacy rights of others, by not sharing them with the media or on the internet/social media.

· Extra-curricular activities that take place in or outside of school and are open to participating schools or community members

may be covered by media and others. In some cases, media may want to feature and/ or interview students. If you do not want

your child to participate in media reports/interviews, please advise the coach and/or indicate your wishes to your child.

· Please note, when events take place in public areas, it may be difficult for the school to prevent the media or others from

recording or photographing students. If you have concerns about your child’s participation in such forums, please speak to the

school principal.

Consent for Other Purposes

In accordance with MFIPPA and the Education Act, releasing personal information for any other purpose requires the informed

consent of:

· the parent/guardian for children under 16 years of age;

· the parent/guardian and the student where the student is 16 and 17;

· the student where the student is over 18 or is 16 or 17 years of age and has withdrawn from parental control.

Questions

Please contact the school principal to discuss any concerns you may have with how these practices affect your child. The above will

apply unless a concern or objection is filed with the principal and an alternative resolution can be found.

Attached you will find an Annual Consent and Notification Form so you may indicate your wishes regarding: use and disclosure of

student work, pictures and recordings on the internet/social media; to media and within the school community; and other

permissions as appropriate. Please complete the form and return it to the school as soon as possible.

  

PERSONAL ELECTRONIC DEVICE USED WITH WI‐FI NETWORK STUDENT AGREEMENT  

Dufferin‐Peel Catholic District School Board policies and procedures support the use of personal electronic devices (PEDs) for educational purposes. This agreement will be signed when your child registers to attend a school within Dufferin‐Peel Catholic District School Board.  In compliance with the Catholic Code of Conduct and other board policies and procedures  including, but not  limited to the Student Network User Application and Agreement, any student opting to use a PED while on school premises for educational purposes is required to adhere to the following:   Part A. 

1. We understand that if I bring my PED to school I must follow board and school policies and procedures regarding appropriate use of technology. 

2. We will be a  responsible digital citizen by adhering  to guidelines  regarding content, security, safety and ethical use  through appropriate use of technology, as outlined in the Catholic Code of Conduct and other board policies and procedures. 

3. We will accurately represent myself while online and that my online interactions are reflective of our Gospel values and virtues. 

4. We understand that PEDs may be used during instructional time and in instructional space only with the expressed permission of the classroom teacher and/or staff and only in a manner that supports the teaching‐learning process.   

5. We understand that I may use my PED in common areas for educational purposes, as designated by the principal. 6. We will not  share my password with others and  I will  respect  the privacy of other people.    I will not  share other people’s 

passwords or personal information. 7. We  understand  that  upon  reasonable  grounds,  staff  reserve  the  right  to  review material  viewed,  created  or  saved  on my 

authorized registered PED and/or other personal electronic devices. 8. We understand that no school and/or board data is allowed to be stored on PEDs. 9. We will not use my PED in a manner that will harm the board’s system or another person's work.  10. We understand that if I bring my PED for use on board premises I am responsible for the safety and security of that device at all 

times and the board assumes no responsibility for lost, damaged or stolen devices. 

11. We understand that we should not have the expectation to be able to charge our device at school.  

12. We understand that photos, videos or images of an individual/group are not permitted to be taken without expressed consent. Expressed consent must be obtained from the individual(s) ‐ over the age of 18—or parental/guardian consent (for those under the age of 18).  

13. We understand the school administration will be the arbiter of what constitutes a violation of this agreement.  Any failure to comply with these guidelines may result in confiscation of my PED, discipline, a loss of PED privileges, police involvement and/or any other consequences deemed necessary by school administration. 

14. We agree, by virtue of access to the board’s computing and electronic communication systems, to indemnify, defend and hold harmless the board for any suits, claims, losses, expenses or damages, including but not limited to litigation costs and legal fees, arising from or related to the user’s access to or use of board electronic communication and computing systems, services and facilities. 

 

Part B. 

1. We understand that I am responsible to take the necessary steps to ensure my authorized PED is connected to the board wireless network, and that the board will not be responsible for any cost incurred through the use of personal data plans. 

 I acknowledge that I have read, understand and agree to abide by the PERSONAL ELECTRONIC DEVICE USED WITH WI‐FI NETWORK STUDENT AGREEMENT.   

     

School     Name of Student (please print) 

     

Student Signature    Date 

     

Parent/Guardian Signature    Date   

Copy to the student and/or parent/guardian 

    GF 337