Summer Teen Program 2022 Registration Package (Page 1) Student Information Form

Group or Agency Name: O-CANADA EXPERT SERVICES

First Name: Tuan

Student Hung
Information Family Name: Nguyen
(Day) (Month) (Year)
Male Female Birth Date: 05/ 04 /2005 Age as of June 16: 17 Citizenship: Vietnam
Student Email: nh929509@gmail/com T-shirt Size: Small Medium Large

Emergency Contact Name: Amia Nguyen Emergency Contact Phone: 41583886375

Emergency Contact Relationship to Student: GROUP LEADER Location: Canada Home Country

Home Address
Street: Ninh Hiep Gia Lam Ha Noi City: Ha Noi
Province/State: Ha Noi Postal Code: 100000 Country: Vietnam

Student Information Flight information

Select your Program: Arrival:
Do you need an airport pick-up? Yes No
Residence Program
Date (DD/MM/YYYY): / /
Self-Arranged Program (No Accommodation)
Time: Airline: Flight #
Starting Date: (DD/MM/YYYY): 10 /07 /2022
Departure:
Finishing Date: (DD/MM/YYYY): 30 /07 /2022
Do you need an airport drop-off? Yes No

Parent/Guardian Information - 1 Date (DD/MM/YYYY): / / Time:

Airline: Flight #
First Name: Thi Thanh Ha
Unaccompanied minor service requested for departure flight?
Last Name: Dang Yes No

Primary Phone: +84979482668 Registration Checklist

Secondary Phone:
The following 3 pages must be complete to register
Email: nh929509@gmail.com
your child for the English School of Canada’s Summer
Note: We must have the email of at least 1 parent on file to send Teen Program. Please be sure you have read through
additional confirmations and forms the whole package, and use this as a checklist to track
your progress!
Parent/Guardian Information - 2
Student Information Form (Page 1)
First Name: Chi Quan
Terms and Conditions Form (Page 2)
Last Name: Nguyen
Registration Payment Information
Primary Phone: +84979482668 Form (Page 3)
Secondary Phone:

Email: nh929509@gmail.com

Proceed to Page 2 to review our policies and terms.

You will receive an email from The English School of
Canada to provide further information in an online form.

79 St. Clair Avenue East, Suite 202, Toronto, Ontario M4T1M6 Canada
Tel: (416) 686-1596 | Fax (416) 686-7960 | www.esc-toronto.com | info@esc-toronto.com
 Summer Teen Program 2022 Registration Package (Page 2) Terms and Conditions Form

The English School of Canada Summer Teen Program operates in June, July and August of every summer. The program runs
Program Details
continuously throughout the summer (including all public holidays). Unless otherwise stated, Monday to Sunday constitutes one full week
of the program (arrivals preferred on Sundays).

2022 Program Start Dates: Conditions of Enrollment:

June 20
June 27 July 04
July 11 August 01**
July 18
July 25*
* = 3 week program only
** = 2 week program only
The last day of residence is August
14
Students can stay anywhere
between 2 and 4 weeks at
our program. However, our
activity
calendar cycles every four
weeks. Please note that a 3
week program will miss some
activities, and a 5 week program
ESC reserves the right to refuse any undesirable registration. ESC reserves the right to change
start dates, programs, activities and course content at any time and without prior notice. Fees,
dates and conditions listed in the brochure or website are subject to change without prior notice.
Courses are available based on enrollment. ESC and its directors and shareholders accept no
responsibility whatsoever for any loss or damage to the personal belongings or property of student
or program participant or for any injury to or death of a student or program participant occurring on
or off school property. Students must comply with the rules of the school and residence as per
the Student Handbook provided upon arrival. Failure to comply with the rules of the school and
or residence may result in dismissal. Neither ESC nor its representatives are liable in cases
where ESC is unable to fulfill any services to which they are contractually bound because of
weather, labour disputes, or other reasons which are beyond their control. The English School of
Canada provides a complete activity schedule for students. Student participation in all activities
is subject to arrival and departure dates.
Please note that health insurance is provided for all students in the Summer Teen Program.
We provide a list of names and insurance numbers to hospitals in advance of your arrival, so
our insurance provider is necessary for all students. For more information on our insurance
policy, visit www.guard.me

Refund Policy
Program Refund

Rejection by Citizenship and Immigration Canada (CIC)

Students who are unable to obtain the necessary permits to enter Canada will receive a 100% refund to program fees, less the $200
registration fee. The school must receive written notification of the cancellation by completing a cancellation/refund request form available
from the school and send a copy of the letter of rejection from Citizenship and Immigration Canada before the refund will be processed.

Cancellation Policy

There is a non-refundable registration fee of $200. In the event that a student must cancel their program, the school must receive written
notification of the cancellation by completing a cancellation/refund form available from the school. Refunds are processed according to the
terms below.
% Program Completed % Tuition Refunded
Cancellation between March 1, 2022 and March 17, 2022 90% (minus registration fee) *Please note that these percentages are
based on complete weeks. Students that
Cancellations within 90 days before the program start date 85% (minus registration fee) request a refund mid-week will have the
0 - 15% of the program duration 50% (minus registration fee) calculations based on the following
week.
16% - 24% of the program duration 30% (minus registration fee)
Over 25% of the program duration 0%
Parent/Guardian Consent
I confirm that I have read and I accept the OFFICE USE ONLY
Conditions of Enrolment, Cancellation and Refund
policies of the English School of Canada as
outlined in this registration package. RECEIVED BY: REGISTERED BY: DATE OF REGISTRATION: _

Parent’s Name: Dang Thi Thanh Ha

Date: 28 /04 /2022

(DD/MM/YYYY)

79 St. Clair Avenue East, Suite 202, Toronto, Ontario M4T1M6 Canada
Tel: (416) 686-1596 | Fax (416) 686-7960 | www.esc-toronto.com | info@esc-toronto.com
 Summer Teen Program 2022 Registration Package (Page 3)
Payment Information and Deposit Form

Payment
The English Information
School of Canada Summer Teen Program provides two methods of payment: Bank Wire Transfers and Payment by Credit
Card. Please read each section below, and notify us of the method you prefer to use.

The SchoolPLEASE NOTE:

must receive in This information
the wire is only
transfer details for families
enough who are
information not
to be represented
able by payment.
to identify the an agent.Please
If you are working
provide with
the student
an agency to register your child for the English
name and at least one of the following unique identifiers: School of Canada, please consult your agent on how to proceed
with
1. ESC Student ID Number
2. Customer and /or Invoice Number
Bank Wire Transfer Information
CANADIAN DOLLARS
Directly from: Canadian Financial Institutions in Canada or Correspondent banks anywhere worldwide.
Beneficiary: English School of Canada Incorporated
Bank Name: Royal Bank of Canada Bank Address: 2 Bloor Street East, Toronto, Ontario, M4W 1A8
Account #: a/c 1035534 Transit: 06702 Institution: 003
ABA: 021000021 Swift Code: ROYCCAT2

Credit Card Payment Information

The School can receive payments made by credit card (we accept Visa, Mastercard, and American Express). This must be done by
completing a “Credit Card Authorization Form”, available from the English School of Canada upon request. Please be in touch with the
contact you have been working with to receive this form for completion.

Payment Schedule and Registration Fee

Payment Deadline

The English School of Canada works with individual families to ensure that all payments are received and processed before the start
of their child’s program. If working with an agency, we will work with a representative to ensure all students under their care have
had all payments received and processed.

Registration Fee

In order for your Registration Form to be processed and to guarantee a space in our program, you must provide a $200
“Registration Fee” which serves as a deposit. This amount will count toward the total cost of your program, it is not an
additional fee. If you are working with an agency, this registration fee has been collected through them.

Method of Payment
Please indicate your preferred method of payment:

I am working with an Agency (All payments will be processed through the agency)

I would like to pay by Bank Wire Transfer (We will send you an invoice with all necessary information)

I would like to pay by Credit Card (We will send you an invoice and Credit Card Authorization Form)

79 St. Clair Avenue East, Suite 202, Toronto, Ontario M4T1M6 Canada
Tel: (416) 686-1596 | Fax (416) 686-7960 | www.esc-toronto.com | info@esc-toronto.com
 CONSENT/WAIVER FORMS

Please read the following information carefully and have a parent (or legal guardian) SIGN and DATE each section.
Either SIGN DIGITALLY, or SCAN and EMAIL the completed form to juniors@esc-toronto.com.

Student Name: Nguyen Tuan Hung Birthdate (MM/DD/YYYY): 04 /05 /2005

ACTIVITY WAIVER
Students enrolled in the ESC Summer Program will participate in a variety of extra-curricular activities in and around Toronto.
Activities are supervised by ESC staff and detailed instructions are provided to students to ensure their safety and security.

I understand and acknowledge that participating in school activities (the "Activity") entails inherent risk and could result in injury to
my property or person and even death. I hereby agree for my child to participate in the Activity and to assume all risk associated
with the Activity and I hereby remise, release and forever discharge the English School of Canada Inc. (the "Corporation") and its
shareholders, directors, officers and employees and their respective successors and assigns, heirs, beneficiaries and legal personal
representatives from all claims, demands, actions, causes of action, and liabilities whatsoever which I or anyone on my behalf had,
now have or may hereafter have for or by reason of or in connection with my child’s participation in the Activity.
I hereby agree not to make any claim or take any proceeding with respect to any matter, cause or thing hereby released or against
any person who might claim contribution or indemnity against any person released herein under the provisions of any statute or
otherwise.
The provisions of this waiver shall be binding upon the undersigned and his/her heirs, beneficiaries and legal personal representa-
tives.

COLLECTION OF PERSONAL INFORMATION CONSENT

According to Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA), organizations in the private
sector must obtain consent from individuals for the collection, use, and disclosure or their personal information. English School
of Canada collects and uses personal information from our students in order to:

1. Maintain a file of your personal information including contact details in case of an emergency
2. Collect statistics for the sole use of ESC’s business development
3. Communicate with an agent or third-party organization acting on a student’s behalf in their country of origin
Photos and Video: ESC may take images of students to promote the school or its programs in print or online. This includes, but is
not limited to, brochures and flyers, ESC website, partner websites, and social media sites (Facebook, YouTube, etc.).
I hereby give consent to English School of Canada to use and disclose my child’s personal information for the purposes of conduct-
ing ESC business, as outlined in this document.

Parent/Guardian Name: Signature: Date (MM/DD/YYYY): 04 /28 / 2022

DAMAGES TO RESIDENCE AND UNIVERSITY PROPERY

The University of Toronto rents various spaces to English School of Canada to conduct its Summer Program operations. These
spaces include student residences (bedrooms, common rooms, cafeteria), classrooms, meeting rooms, and mixed-use lounges.
Damages to any university property will be charged back to the student who is at fault.

Damages include, but are not limited to, breaking or scratching furniture, defacing furniture or walls (graffiti), or any acts requiring
extra cleaning. ESC has put into place the following procedures:
1. Students who have caused damages of any kind will be issued an invoice for the cost of replacement/repair, which must be paid
in full prior to the student departing from Canada
2. Upon check-in to the residence, an ESC staff member and the student will inspect the bedroom and make detailed notes of any
existing damages. Upon check-out of the residence, an ESC staff member will inspect the room again and the student will be
charged for any damages present
I understand that If a student is seen causing damage or is known to have caused damage to university property, ESC will issue an
invoice with payment instructions to the student’s parents for the appropriate repairs or replacement.

Parent/Guardian Name: Signature: Date (MM/DD/YYYY): 04 /28 /2022

 CONSENT/WAIVER FORMS

Please read the following information carefully and have a parent (or legal guardian) SIGN and DATE each section.
Either SIGN DIGITALLY, or SCAN and EMAIL the completed form to juniors@esc-toronto.com.

Student Name: Nguyen Tuan Hung Birthdate (MM/DD/YYYY): 04 /05 /2005

MEDICAL INFORMATION & WAIVER

At the English School of Canada, the safety, security and health of your child are our first priority. By completing this form to the
best of your ability, you are providing us with the documentation we need in the case of an emergency. We appreciate your coop-
eration in making sure that we are prepared for any situation that may present itself. If there is further information regarding
your child’s health that ESC should be aware of, please include it the email when returning this document.
Does your child have any allergies? Please specify: NA
 Please explain the typical allergic reaction experienced by your child: NA

Will your child be taking any medication while at camp? Please list the name and frequency: NA
 Does your child require supervision or assistance with their medication? NA

Does your child have any existing medical conditions? (E.g. Asthma, Diabetes, etc.) NA
 Do these medical conditions require special assistance? NA

I understand that The English School of Canada Inc. is renting facilities (including residence, classrooms, and activity spaces) for the
camp and cannot guarantee an allergy free environment for the duration of the camp. By signing below I voluntarily assume and ac-
cept any risks associated with such an environment. Furthermore I hereby release all personnel involved with the Summer Teen Pro-
gram from any and all possible claims, liabilities, obligations or responsibilities arising from any allergic reaction my child might
suffer.
While ESC staff and instructors will make every reasonable effort to minimize exposure to known risks associated with each Regis-
trant’s participation in an ESC program (“Summer Teen Program”), I hereby acknowledge that I and/or my child if I am registering
on his/her behalf (collectively, the “Registrant”) may be required, depending on the nature of the Program, to participate in various
physical activities that may involve risk of injury. In this regard, I agree that I have provided a complete and accurate health history
and hereby permit the Registrant to participate in the full range of Program activities, except as specifically noted by me in the health
information section of the Program registration (where applicable). In consideration for the Registrant’s opportunity to participate in
the Program, the receipt and sufficiency of which is hereby acknowledged, I hereby release and forever discharge the English School
of Canada Inc. ("ESC"), its respective officers, directors, employees, volunteers and agents, and their respective successors and as-
signs, from any and all liability for damages sustained in consequence of loss, injury or damage to the Registrant, and from all other
actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss or damages to any person or
property arising out of or connected with preparation for, or participation in, the Program.
In the event of an accident, injury or illness involving the registrant, and immediate contact by the ESC with a designated contact
cannot be made, I hereby authorize and grant permission to ESC staff to secure proper medical treatment and authorize on the regis-
trant’s behalf all procedures, including, without limitation, admission to an emergency unit, hospital and treatment therein, ordering
of x-rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s). I
agree not to hold ESC responsible for any costs or injury arising out of an emergency situation.

Parent/Guardian Name: Signature:

Date (MM/DD/YYYY): 04 /28 /2022