SUMMER INDEPENDENT LEARNING COURSES (ILC)

Application to Attend

A student attending secondary school may enrol in the Summer ILC program with written permission from his/her day school principal/designate and has parental consent if under 18 years of age.

All course material and final examination must be completed by August 26th, 2015

* A SEPARATE FORM IS REQUIRED FOR EACH COURSE TAKEN *

PLEASE PRINT CLEARLY:

Student's Name:

Last Name First Name Date of Birth mm/dd/yyyy

Address:

Number Apt No Street City Postal Code

Contact Numbers:

Home Cell E-Mail

Day School:

Course Requested:

Course Code New Credit Upgrade Credit Previous Mark

Course Location:

St. Charles Mountain Centre, 150 East 5th Street

Course Fee:

$25 Book deposit (refundable when the book is returned in good condition)

Registration, Course Material Pick Up, Lesson Drop Off and Marked Lesson Pick Up:

Credit Office St. Charles Mountain Any time from July 8 August 7, 2015 9 a.m. 3 p.m.

Teacher Availability: Wednesdays from 1:00 3:00 p.m. only throughout July and August

As a parent/guardian of the above noted student, I approve for my son/daughter to participate in the St. Charles ILC Summer Program for Secondary students.

__________________________ _________________ ________________________ ________________

Parent's Signature Date Students Signature Date (If student is under 18)

I verify that this student has the pre-requisite required for the course requested above.

Principal/Designate:

Printed Name Signature Date

PERMISSION GRANTED BY DAY SCHOOL