Grade 10 Registration Package 2016 – 2017

Grade 10 Registration Package
2016 – 2017
All Registrations submitted MUST have the following completed
to ensure your child has been successfully enrolled:
** please check  if completed & attached **
 Most recent Grade 9 Report Card attached
 Copy of Birth Certificate or Passport attached
 Ensure Course Selection sheet completed (pg 3)
 Ensure both Student & Parent(s) email addresses are supplied (pgs 5 & 6)
 Ensure DECLARATION page has been signed by Legal Guardian (pg 7)
 Ensure NON-RESIDENT STUDENT APPLICATION FORM is filled out UNLESS transferring from
WD CUTS, SGS, GISH, AKINS (ie: St. Albert Catholic, EPSB, out of Province, etc)
(pgs 13 & 14)
 Ensure SIGNATURE PAGE is signed by both Parent & Student (pgs 15 & 16)
 If your child currently attends GISH, SGS, CUTS or AKINS, please return completed
Registration Forms directly to your Jr High by March 24th, 2016
 If your child currently attends a Jr High not listed above, please return completed
Registration Forms directly to Bellerose Composite High School by April 11th, 2016
For more information, please visit bchs.spschools.org
Page1
HIGH SCHOOL PLANNER
GRADE 10
Course
Level Credits
GRADE 11
Marks
Course
Level
Credits
GRADE 12
Marks
Course
Level
English 10-2
English 10-1
Social Studies 10-2
Social Studies 10-1
Math 10-3
Math 10 C
English 20-2
English 20-1
Social Studies 20-2
Social Studies 20-1
*Math 20-3
*Math 20-2
*Math 20-1
*English 30-2
*English 30-1
*Social Studies 30-2
*Social Studies 30-1
Math 30-3
Math 30-2
Math 30-1
Science 10
Science 14
*Phys. Ed. 10
*Science(s)
Science(s)
Others
*CALM 20
*10 Credits in CTS
Or
Fine Arts Or
Credits
Phys. Education 20
Or Phys. Education 30
*Two 30 level courses
other than English &
Social Studies
Total Credits:
Credits should total 40 – 43
Total Credits:
Credits should total 37 – 40
Total Credits:
Credits should total 105 minimum
*Required for Diploma
CREDIT TOTAL:
Page2
Marks
Bellerose Composite High School
Grade 10 Registration
Name
Phone #
(Last name, First name)
Current School
____
How to Select Your Grade 10 Courses
For details regarding course content, please consult your
Bellerose Guidebook. This Guidebook is available on our
BCHS website at http://bchs.spschools.org/ under the
Registration Tab.
Step 3 - Elective Courses
*** NUMBER from 1 to 6 (#1 being your first choice)
Second Languages
Step 1 - Think ahead
# of credits
___French 10-9Y
___German 10
___Spanish 10
Grade 10 students must sign up for a full timetable which
is a minimum of 40 credits (no spares).
5
5
5
Fine Arts
___Art 10
___Choral Music 10
___Drama 10
___Instrumental Jazz 15
___Instrumental Music 10
___Guitar 15
___Vocal Jazz 15
___Film Studies 15
Step 2 - Core Courses
Choose one class from each of English, Math, Science and
Social Studies.
English Language Arts
# of credits
English 10-1
English 10-2
5
5
Career and Technology Studies (CTS)
Mathematics
Math10C
Math 10-3
5
5
Science 10
Science 14
5
5
___Architectural Design 1C
___Computer Science 1C
___Construction Tech 1C
___Cosmetology 1C
___Digital Media & Design 1C
___Digital Photography 1C
___Fashion Studies 1C
___Food Studies 1C
___Interior Design 1C
___Make It!
___Mechanics 1C
___Medical Studies 1C
___Outdoor Ed 1C
___Personal Fitness 10
___Personal Fitness / Crossfit
___Sports Med and Rec 1C
Science
Social Studies
Social Studies 10-1
Social Studies 10-2
5
5
Physical Education & CALM
___CALM 20 (1 Semester, every other day)
___Hockey Academy 10
3
5
___Phys. Ed. & Yoga 10
___Phys. Ed. & CALM 20
Physical Education 10 (boys)
Physical Education 10 (girls)
6
6
5
5
(Includes Phys. Ed 10)
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
3-5
5
5
Additional Courses
___Bulldog Films (full year, once a week, after school) 5
___High Performance Sports (during FLEX)
3-10
___Leadership 15 (Student Activities)
5
(this is a full year course, 2 times a week, during FLEX)
___Work Experience (must be employed)
You must choose Physical Education unless you plan
to take it during Summer School or are taking it as
part of Hockey Academy 10.
TOTAL CREDITS
Page3
5-10
_____/40
Page4
STUDENT REGISTRATION FORM (K – 12)
REGISTRATION INFORMATION (Please Print)
STUDENT INFORMATION
Student’s Legal Last Name:
Student’s Legal Given Name(s):
Student’s Alberta Student
Number:
Student Also-Known-As (if different than above)
Last Name:
Given Name(s):
Date of Birth: (DD/MM/YYYY)
Street Address:
City:
Home Phone Number:
Mailing Address (if different than street address):
Citizenship:
Canadian?
Province:
Postal Code:
Gender:
Male
Female
Student’s Cell Phone Number:
Student’s E-mail address:
Yes
No
Citizenship, if not Canadian: (This section does not need to be filled out if student is Canadian).
Student Visa Authorization
Permanent Resident/Landed Immigrant
Student Visa Expiry Date:
(DD/MM/YYYY) (Attach Copy)
Child of Canadian Citizen
Child of Individual Lawfully Admitted to Canada for Permanent or Temporary Residence
Other
_________________________________________
NOTE: The student’s Birth Certificate, Canadian Citizenship Certificate, Passport, Visa, Permanent Landed Immigrant
document or other official document must be given along with this form in order to register. A photocopy will be placed in
the Student Record.
Name of Official Document (please specify):
Copy Attached
SCHOOL INFORMATION
Name of School at which student is registering:
Bellerose Composite High School
Start Date: (DD/MM/YYYY)
Grade Entering:
Program Requested: (Please check one)
Regular English Program
Cogito
Kindergarten Preference:
French Immersion Program
Late French Immersion
Do you require bus service? Yes
Special Education
International Baccalaureate
No
(If Applicable) Name of Previous School Attended:
Logos Program
Advanced Placement
a.m.
p.m.
full-day
If yes, please complete a bus pass application available online
@ http://www.spschools.org/spschools-transportation-store
Grade Completed:
Address of Previous School:
School Withdrawal Date:
(DD/MM/YYYY)
Phone Number of Previous
School:
Fax Number of Previous
School:
A copy of the student’s most recent report card would be appreciated.
Yes, I have attached one
FOR OFFICE USE ONLY:
No, I have not attached one
Date Rec'd ______________
Rec'd by: ______________
Program: ______________
IPP: Yes / No
___ Counted
___ Course Select
___ Birth Cert Rec'd
___ Demographics Entered ___ CUM Requested ___ Transcript Rec'd
Page5
LEGAL GUARDIAN INFORMATION
#1.
Father
Other
Mr.
Mother
Guardian
#2.
(please specify):
Mrs.
Other
Ms.
Last Name:
Father
Miss
Mr.
Dr.
First Name:
Mother
Guardian
(please specify):
Ms.
Mrs.
Last Name:
Miss
Dr.
First Name:
Street Address (Note “same” if not different from student’s – page 1):
Street Address (Note “same” if not different from student’s – page 1):
City:
City:
Province:
Postal Code:
Country:
Provi
nce:
Postal Code:
Country:
Home Phone Number:
Business Phone Number:
Home Phone Number:
Business Phone Number:
Cell Phone Number:
Other:
Cell Phone Number:
Other:
Email:
@
Email:
@
CUSTODY/GUARDIANSHIP INFORMATION
Student lives with
Both Parents
Other
Mother Only
Father Only
Guardian
Foster Home
Independently
(If other, please explain):
Are there any Court Orders affecting guardianship rights, custody, or access to the student?
Yes*
No
* If Yes, the school must be supplied with a copy of the Court Order (with the court seal evident). A photocopy will be placed in the Student Record.
Copy Provided
EMERGENCY CONTACTS
It is essential that you provide the names and phone numbers of individuals who have given their permission to be contacted in the case of
emergency (other than parents/guardians listed above).
Name:
Relationship to Student:
Phone Number:
Name:
Relationship to Student:
Phone Number:
Name:
Relationship to Student:
Phone Number:
Name:
Relationship to Student:
Phone Number:
MEDICAL INFORMATION
Does your child have any medical conditions or allergies the school should know about or that may affect his/her attendance at school?
Yes
No
If yes, please give a brief description:
Doctor’s Name (optional):
Doctor’s Phone Number (optional):
SPECIAL NEEDS INFORMATION
Does your child have any physical, intellectual, behavioral or emotional needs which would impact our ability to provide an appropriate educational
program?
Yes
No
If yes, please, please explain:
Has your child had any previous special needs testing or assistance?
Yes
No
If yes, please provide program name and contact:
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DECLARATIONS
INDEPENDENT STUDENT STATUS
Students 18 years of age and older, or “living independently”:
The School Act defines an independent student as someone who is (i) 18 years of age or older; or (ii) 16 years of age or older and (a) who is living
independently, or (b) who is a party to an agreement under Section 57.2 of the Child, Youth and Family Enhancement Act.
Do you qualify for status as an “Independent Student” under the definition of the School Act?
Yes
No
If yes, please attach proof of
independent status. (If claiming independent student status, you may complete this form and register in the school district without parental consent).
ABORIGINAL LEARNER DATA COLLECTION INITIATIVE
If you wish to declare that you are an Aboriginal person, please specify:
Status Indian/First Nations
Non-status Indian/First Nations
Metis
Inuit
Alberta Education is collecting this personal information pursuant to section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act
as the information relates directly to and is necessary to meet its mandate and responsibilities to measure system effectiveness over time and
develop policies, programs and services to improve Aboriginal learner success. Alberta school boards are also collecting this information pursuant to
the same section in conjunction with section 2(1) (t) of the Student Record Regulation and for the same purposes. This information will also be used
to determine the provincial First Nations, Métis and Inuit funding allocation provided to school authorities.
For further information or if you have questions regarding the collection activity, please contact the Office of the Director, Aboriginal Policy, Strategic
Services Division, Alberta Education, 10155-102 Street, Edmonton, AB, T5J 4L5, phone (780) 427-8501. If you have any questions regarding the
collection activity by St. Albert Public Schools, please contact the District’s FOIP Coordinator, Michael Brenneis, Associate Superintendent of Finance
at 60 Sir Winston Churchill Avenue, St. Albert, AB, T8N 0G4, phone (780) 460-3712.
SECTION 23 ELIGIBILITY (FRANCOPHONE EDUCATION)
According to Section 10 of the School Act and Section 23 of the Canadian Charter of Rights and Freedoms the following applies:


Citizens of Canada
whose first language learned and still understood is French, or
who have received their primary school instruction in French
have the right to have their children receive primary and secondary school instruction in French.

Citizens of Canada
of whom any child has received or is receiving primary or secondary school instruction in French in Canada,
have the right to have all their children receive primary and secondary school instruction in the same language.
According to this criteria, are you eligible to have your child educated in French?
Yes
No
If yes, do you wish to exercise your right to have your child educated in French?
Yes
No
NOTE: In Alberta, parents can only exercise this right by enrolling their child in a French first language (Francophone) program offered by a
Francophone Regional Authority. To exercise your Section 23 rights you must enroll your child with a Francophone Regional Authority.
The provincial Student Record Regulation requires St. Albert Public Schools to release certain demographic information about the student and parent
to the local Francophone Education Board upon written request from that school jurisdiction.
A child or student may be eligible for English as a Second Language (ESL) supports when the primary language spoken at home is a language other
than English and a current school year assessment demonstrates insufficient fluency in English to achieve grade level expectations in English
Language Arts and other subject areas.
According to these criteria, do you believe your child qualifies for ESL?
If yes, please specify the primary language spoken at home:
Yes
No
DECLARATION BY LEGAL GUARDIAN (OR STUDENT, IF STUDENT IS LIVING INDEPENDENTLY)
I hereby declare I have read and understood the information contained on this Student Registration Form and that the information I have
provided above is true, accurate and complete. I accept responsibility to advise the school if there are any changes to this information.
(Signature Required)
Name (Please Print):
Signature:
Page7
Date (MM/DD/YYYY):
Signature Required
ENGLISH AS A SECOND LANGUAGE (ESL) ELIGIBILITY
Page8
FOIP NOTIFICATION
Freedom of Information and Protection of Privacy (FOIP) Act
Collection of Personal Information Notice under s. 34 of the FOIP Act
The FOIP Act, which came into effect for school boards on September 1, 1998, sets controls and standards on how public
bodies, such as school boards, collect, use and disclose personal information that is in their custody or under their control.
The FOIP Act requires that school boards collect personal information directly from individuals the information is about,
that these individuals be provided with the legal authority for the collection, be explained the purpose of the collection and
how the information will be used, and be provided a contact person should they have any questions relating to this
activity.
The information collected on this form as part of the school registration process is personal information as referred to in
the FOIP Act. This personal information is collected pursuant to the provisions of the School Act and its regulations (e.g.
for the establishment of a student record, determination of residency) and pursuant to section 33(c) of the FOIP Act as the
collection is related directly to and is necessary to a school board's obligation to provide students with an education
program that meets their needs and to provide a safe and secure school environment (e.g. program placement,
determination of eligibility and/or suitability for provincial or federal funding, contact and health related information in the
event of problems or emergencies). Personal information may also be provided to the Minister of Education for the
purpose of carrying out programs, activities, or policies under his administration (e.g. research, statistical analysis).
This information will be made available to employees of St. Albert Public Schools and the Board of Trustees within the
scope of their roles and responsibilities, and to individuals working with the children in schools and Alberta Education, on
a need to know basis. Please read the following information about the types of activities for which personal information is
collected. The information will be used for authorized programs and activities that are vital to a healthy, well functioning
school life. We realize that there may be occasions where you have concerns relating to the safety of your child with
respect to any of the uses of this information. In such cases, please contact the principal of the school where your child
attends to discuss your concerns.
The uses to which the personal information collected on the registration form may be put, which are considered part of a
vital, healthy and well functioning school are listed below. In order to assist the Board in maintaining a vital and healthy
environment, participation of all students is important and encouraged. The activities where personal information may be
used are:

The use of student’s name, photograph or comments about the student in the school calendar, newsletter, year book,
graduation book or other school publications.

The taking of individual, class, club or team photos for school purposes and the use of student photos for the issuance
of student identification cards and student report cards.

The use of student names on artwork or other creative work or material of students displayed at the school or district
sites or at school or district sponsored displays within the community; provided that a copyright consent form has
been signed respecting the works created by each student.

The use of student names, related contact information and telephone numbers for absenteeism verification, for
kindergarten parents’ information or for distribution to parents regarding field trips.

The use of family name and address information for the purpose of satisfaction surveys.

The use of student names’ for recognition purposes on honour rolls, at graduation ceremonies, and for scholarships or
receipt of other awards or for birthday recognition purposes within the school or jurisdiction.

The use of student names on class lists posted for the purpose of class placement for the coming school year.

The use of student names and academic information necessary for determining eligibility or suitability for provincial
federal or other types of awards or scholarships in the event the Board applies on the student’s behalf.
Page9

The use of student’s name, address, parental and emergency contact information, for the provision of transportation
services.

The taking of photos and/or videos of classroom or other school sponsored activities and their use by the media or
other organizations where students are not identified by name or face, or interviewed. Where individual students are
identified or interviewed and the material will be used outside the school, a separate and specific consent will be
required. You will be contacted prior to such events taking place. Please note that photos and/or videos of school
activities that are open to the general public may be taken and used for purposes outside the school.

The taking of photos or videos of classroom or other school activities by school board personnel or agents for nonprofit and educational purposes, where the material will be used within the school. Where individual students are
identified or interviewed and the material is to be used outside the school, separate and specific consents will be
required. You will be contacted prior to such events taking place.

The public may access school newsletters through the respective school websites. The newsletters regularly include
news items such as student activities, sports clubs and recognition of students who have received awards. Student
names and/or pictures may also be included.
The information collected on the student registration form is required to allow the Board, through its
administrators to make such decisions as are necessary in order for it to fulfill its obligation to provide
students with an appropriate education program, to provide a safe and secure environment, to protect
the student’s rights and to determine eligibility for particular programs and the funding available both
under the School Act and Regulations and through the Charter of Rights and Freedoms.
The information will be made available to employees of St. Albert Public Schools, its authorized agents,
and the Board of Trustees, within the scope of their roles and responsibilities, and to individuals
working with the students in schools and to Alberta Education on a need to know basis.
The information will be used for authorized programs and activities that are a part of normal school life.
We realize that there may be occasions where you have concerns relating to the safety of your child
with respect to any of the uses of this information. In this case, please contact the
principal/administrator at the school where your child attends or the District’s FOIP Coordinator,
Michael Brenneis, Associate Superintendent of Finance at 60 Sir Winston Churchill Avenue, St. Albert,
AB, T8N 0G4, phone (780) 460-3712.
If you wish to request that your child’s personal information be withheld for any reason, please contact
the school principal directly.
I have read St. Albert Public Schools FOIP Notification and understand that my child’s personal
information will be used to provide an educational program that meets their needs and provides
a safe and secure school environment.
Student’s Name:
Guardian’s Name:
Guardian’s Signature (or student’s, if living independently):
Date (MM/DD/YYYY):
Page10
LEGAL GUARDIANSHIP
Effective October 2005, amendments to the School Act provide that a “parent” is:

the guardian as set out in section 20 of the Family Law Act (“FLA”); or

the guardian appointed under Part 1 Division 5 of the Child, Youth and Family Enhancement Act or Section 23 of
the FLA
(which definition governs the vast majority of situations); or

the individual who has care and control of the student if the student’s guardian resided in Alberta and has
changed residence so that it is outside of Alberta or unknown; or

the guardian appointed under a temporary or permanent guardianship order or agreement under the Child, Youth
and Family Enhancement Act; or

the Minister of Justice and Attorney General if the student is in custody.
While a parent is usually the legal guardian of their child, that is not always the case. Guardianship rights can be shared
by parents or can be lost. As a student’s right to attend any particular school is based upon the residence of the “parent”,
and as it is the parent who exercises the various powers, responsibilities and entitlements as a guardian under the School
Act, it is important that a school board determine who the legal guardians are for any particular child.
The FLA provides that, subject to any order of a court regarding guardianship of the child, the mother and father of the
child are both the guardians of the child where the mother and the father:

were married to each other at the time of the birth of the child; or

were married to each other and the marriage was terminated by a decree of nullity of marriage, or a judgment of
divorce granted less than 300 days before the birth of the child; or

married each other after the birth of their child; or

cohabited with each other for 12 consecutive months during which time the child was born; or

were each other’s adult interdependent partners at the time of the birth of their child or became each other’s adult
interdependent partners after the birth of their child.
If the above does not describe your relationship, guardianship is determined based on residence of the child. Section
20(3) of the FLA provides that the mother and the father are both the guardians of the child until such time as the child
usually begins to reside with one of the parents, at which time that parent becomes the sole guardian of the child; or if the
child lives with both parents, or alternatively, with each parent for substantially equivalent periods of time, both parents
become the guardians of the child.
Despite subsection 20(3) of the FLA, if both parents agree in writing, both parents continue to be the guardians of the
child even after the child begins to usually reside with only one of them. A parent with whom the child has usually resided
for one year is the guardian of the child, even if the child no longer resides with that parent.
The FLA is provincial legislation that defines guardianship rights in Alberta. Parental rights may also be described using
the terms of custody and access in cases where the parties are divorced or have commenced legal proceedings under the
Divorce Act. The School Act provides that where a person claims to be a parent or guardian, or claims the existence of
any limitation on the authority of a parent or guardian, the onus is on that person to provide proof of the claim. Please
provide copies of any current orders or agreements addressing guardianship rights, responsibilities, and entitlements or
otherwise affecting the custody of or access to your child or child’s information to school administration.
Page11
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60 Sir Winston Churchill Avenue
St. Albert, Alberta T8N 0G4
NON-RESIDENT STUDENT APPLICATION FORM
Please complete form if student is coming from a school OUTSIDE of the St. Albert Public School District
Date:
1. Demographic Information
(Surname)
Date of Birth
(Day)
(Month)
(First Name)
(Second Name)
Grade
(Year)
Parent/Guardian Surname
First Name(s)
Address
Postal Code
Phone (Residence)
Phone (Business)
2. Resident Board:
3. Please identify the educational needs of your child.
a)
Academic:
b)
Behavioural/Emotional:
c)
Physical:
d)
Other:
Page13
e)
Does your child have any needs that would require a special education program, if so, please
describe:
4. Current Academic Functioning:
 Please provide a copy of the most recent report card.
5. Rate your child’s overall academic range:
Weak
Below Average
Average
High Average
Superior
6. School History:
 Please include: Schools attended, grades repeated, special programming
7. Reason for Application:
8. Should your child require a special needs program, as a non-resident student, you may be
required to return to your resident district, due to insufficient resources.In accordance with
the St. Albert Public School District #5565’s policy on Resident/Non-Resident Student
Status/Admissions, I do give permission for the school Principal or designate to contact my
child’s current/previous school(s) to obtain information which will help determine the
educational needs of my child.
Date
Parent/Guardian Signature
District School
Page14
SIGNATURE PAGE
Issued as of FEBRUARY 2016
Bellerose Composite High School
Dear Parents,
This package of information is crucial to the registration of your son/daughter at Bellerose for the School Year 2016/2017
Various School District Policies require that parents and/or students acknowledge an awareness of several of these
policies. The fact is that access to particular programs is impossible without the consents and acknowledgements involved
with these policies. Over the years, the human resources at the school used to ensure the forms are signed and returned
has been quite a troubling point to me. We are attempting to streamline the process with this package. As well, we will
only process a timetable for a student once the “forms” are returned. With ensuring there is no delay in mind, it is
imperative that the “Signature Page” be separated from the information package and returned to Student Services along
with your Registration Forms.
In order to simplify the process we have combined all the necessary signature blocks on one piece of paper. The
remainder of the material provides all the information related to the various signatures required. Again, we appreciate your
help with this process. As you read the material you will become aware of the impact not providing consent would have on
such things as computer use, behavioral expectations and information provision.
Thank you in advance and if you have questions please email me at jyoti.mangat@spschools.org
STUDENT NAME ________________________________ I.D. # ________________ GRADE: ________
SIGNING AGREEMENTS FOR THE FOLLOWING GREY FORMS CONTAINED IN THIS PKG:
1.
2.
3.
4.
5.
Student Acceptable Use of Technology
Freedom of Information and Protection of Privacy Act
License to Use School Locker
Froshing - Assault & Abduction Contract
Drug Free Schools
 Please check that all
 5 (five) forms have been
 read and signed.


***MUST BE SIGNED BY PARENTS & STUDENTS AND RETURNED WITH REGISTRATION***
1. STUDENT ACCEPTABLE USE OF TECHNOLOGY AGREEMENT
Section A: I have read the Acceptable Use of Technology Guidelines. I agree to follow the rules contained in these guidelines. I
understand that if I violate the rules, my account can be terminated and I may face other disciplinary measures.
Student Name: ____________________________Signature _____________________________ Date_________
Parent Endorsement: I have reviewed this document and each paragraph with my child. I have discussed the importance
of this agreement with my child. I understand that computer access is for educational purposes. I will instruct my child
regarding acceptable use, including that which is set forth in the Acceptable use of Technology Guidelines and
Agreement. I will emphasize to my child the importance of following the rules for personal safety.
I hereby release St. Albert Public Schools and its personnel from any and all claims and damages arising from my child’s
use of, or inability to use, the St. Albert Public Schools’ computer systems. I give permission to allow internet access for
my child and certify that the information contained in this form is correct.
Parent Name: ____________________________Signature _____________________________ Date_________
Section B: Use of personal computing devices at school. I have read the Acceptable Use of Technology Guidelines and
Agreement for the use of personal computing devices at school. I accept all responsibility when bringing my own
personal computing device to school.
Student Name: ____________________________Signature _____________________________ Date_________
Please turn page over 
Page15
Parent Endorsement: I have reviewed this document and each paragraph with my child. My child understands the
expectations and responsibilities associated with using a personal computing device at school as well as the appropriate
and ethical use of the technology. I hereby release St. Albert Public Schools and its personnel from any and all claims and
damages arising from my child’s use of, or inability to use, their personal wireless device on the school’s wireless
network. I give permission to allow my child to bring his or her personal computing device to school for educational use.
Parent Name: ____________________________Signature _____________________________ Date_________
Section C: Use of Google Docs for education. I have read the Acceptable Use of Technology Guidelines and Agreement
for the use of Google Apps for Education. I accept all responsibility for using my Google Apps for Education account and
email address as set forth in this document.
Student Name: ____________________________Signature _____________________________ Date_________
Parent Endorsement: I have reviewed this document and each paragraph with my child. My child understands the
expectations and responsibilities associated with having an email address and using a Google Apps for Education account.
I hereby release St. Albert Public Schools and its personnel from any and all claims and damages arising from my child’s
use of, or inability to use, the Google Apps for Education account. I give permission to allow my child to have an email
address issued by St. Albert Public Schools.
Parent Name: ____________________________Signature _____________________________ Date_________
2. FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY (FOIP) ACT
Parent & Guardian Section: I have read St. Albert Public Schools FOIP Notification and understand that my child’s personal
information will be used to provide an educational program that meets their needs and provides a safe and secure environment.
Parent Name: ____________________________Signature _____________________________ Date_________
Over 18 Student Signature _____________________________________ Date ________________
3. LICENSE TO USE SCHOOL LOCKER
Students Section: I have read the acceptable guidelines. I understand that if I violate the rules, my account can be
terminated and I may face other disciplinary measures.
Student Name: ____________________________Signature _____________________________ Date_________
4. FROSHING – ASSAULT & ABDUCTION CONTRACT
Students Section: I hereby acknowledge and I have read and understood the Froshing - Assault & Abduction Contract.
Student Name: ____________________________Signature _____________________________ Date_________
5. DRUG FREE SCHOOLS & DRUG FREE PROTOCOL
Students Section: I, hereby, acknowledge that I have read and understood the Drug Free Schools & Drug Free Protocol
information and notification.
Student Name: ____________________________Signature _____________________________ Date_________
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RELEASE OF LIABILITY, WAIVER OF CLAIMS,
ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
TO STUDENT AND STUDENT’S PARENT/GUARDIAN:
WARNING:
By signing this document you will waive certain legal rights, including the right to sue.
I am aware that the use of the Bellerose Composite High School Fitness Centre (the “Fitness Centre)
includes the potential use of equipment, including but not limited to: free weights, spinner bikes, ropes,
elastic band equipment [include other equipment in the Fitness Centre] and participation in activities such
as [include activities e.g. yoga, pilates, aerobics, etc.]
I am further aware that the use of any and all equipment in the Fitness Centre or participation in activities
in the Fitness Centre involves inherent risks, dangers and hazards, including, but not limited to:
(a) neck and spinal injuries which may result in complete or partial paralysis, brain damage,
blindness;
(b) injury to internal organs;
(c) injury to bones, joints, ligaments, muscles tendons and other aspects of the muscular skeletal
system;
(d) injury or impairment to other aspects of my body, general health and well-being; and
(e) death.
I understand that the dangers and risks of using any and all equipment in the Fitness Centre or
participation in activities in the Fitness Centre include not only in serious physical injury to me/my child,
but in a serious impairment of my/ my child’s future abilities to earn a living, to engage in other business,
social and recreational activities.
Because of the inherent dangers of using any and all equipment in the Fitness Centre or participation in
activities in the Fitness Centre, I confirm that I am/my child is medically fit to use any and all of the
equipment in the Fitness Centre. Furthermore, I recognize the importance of following the teacher’s
and/or the fitness coach’s instructions regarding techniques, training and other rules, and I/my child
agree(s) to obey such instructions and rules.
I/my child agree(s) not to use any or all of the equipment in the Fitness Centre or participate in activities in
the Fitness Centre without the supervision of a teacher or the fitness coach.
I/my child freely accept(s) and assume(s) all such risks, dangers and hazards and possibility of personal
injury, death, property damage or loss resulting therefrom.
I/my child agree to notify my/my child’s physical education teacher and the fitness coach of any current
and future injuries or medical conditions that may affect my/my child’s risk of injury in using any or all of
the equipment in the Fitness Centre or participation in activities in the Fitness Centre.
In consideration of the use of the Fitness Centre and equipment of St. Albert Public School District No.
5565, I hereby agree as follows:
(a) TO WAIVE ANY AND ALL CLAIMS of every nature and kind at law or in equity or under any
statute that I have or may have in the future against the ST. ALBERT PUBLIC SCHOOL
DISTRICT NO. 5565, its trustees, employees, agents, volunteers, representatives and
independent contractors (hereinafter collectively referred to as the “School”);
(b) TO RELEASE THE School from any and all liability for any loss, damage, injury or expense that I
or my child may suffer or that my next of kin or legal representatives may suffer as a result
of my or my child’s use of any or all of the equipment in the Fitness Centre or participation
in activities in the Fitness Centre due to any cause whatsoever, including negligence on the
part of the School;
(c) TO HOLD HARMLESS (which means to assume liability inherent in a situation, thereby relieving
the other party of responsibility) the School from any and all liability for any property
damage, personal injury to any third party or other financial loss or expense, including legal
expenses and costs resulting from the use of any and all of the equipment in the Fitness
Centre or participation in activities in the Fitness Centre; and
(d) THAT this Agreement will be effective and binding upon me, my heirs, next of kin, executors,
administrators and assigns.
________________
Date Signed
_______________________
Student Signature
_________________________
Witness
PRINT NAME:
_______________________
Student Name
_________________________
Witness Name
FOR STUDENT’S PARENT/GUARDIAN:
This is to certify that I, as parent/guardian with legal responsibility for the Student who has signed above,
do consent and hereby agree to his/her release and waiver as provided in this Agreement.
________________
Date Signed
_______________________
Parent/Guardian
Signature
_________________________
Witness
PRINT NAME:
_______________________
Parent/Guardian
_________________________
Witness Name