Club Connect

Club Connect
Online learning programs are for students who qualify for APSEA services. Registration must be completed by their APSEA Education Support Teacher (EST).
Education Support Teacher Name:*

First NameLast Name
Education Support Teacher Email Address:*
example@example.com
Session Selection
Please select the group sessions to attend:*

Junior Group (Grades 3 - 6)Senior Group (Grades 7 - 9)
Student Information
Student Name:*

First NameLast Name
Grade:*
If Other, please specify grade:*
City/Town:*
Province:*
Communication Mode:*
School Information
School District/Regional Centre for Education*
School Name:*
School Team Contact Name:*
School Team Email Address:*
example@example.com
School Team Member Role:*
If Other, please specify:*
Is the above school contact facilitating participation in this virtual program?*

YesNo
If no, please identify who is responsible for ensuring the learner is adequately set up to participate in this program?
Full Name:*
Email Address:*
example@example.com
Informed Consent for Student Participation for Online Programs:*

Uploaded to the APSEA DatabaseCompleted forms have been sent in by email. (NL and PE)
Permission to Record or Photograph:*

Uploaded to the APSEA DatabaseCompleted forms have been sent in by email. (NL and PE)
Level of permission to record or photograph:*
Note: By completing this registration you are agreeing that the applicable required permission forms have been uploaded to the APSEA database or have been emailed.
Feedback
How did you hear about this program?*
If Other for how you found out about this program, please specify
Should be Empty:

Club Connect

Session Selection

Student Information

School Information

Feedback