(stem)...science, technology, engineering and math (stem) education is among the most competitive...

Science, Technology, Engineering and Math (STEM) education is among the most competitive and sought after programs in the world. STEM promotes innovation, critical thinking, and science literacy. In today’s world of ever-evolving technology, the trajectory of the future of education and the career sector is contingent on an increased need for basic and advanced application and understanding of math and science.

The STEM National Leadership Program (SNLP) is available to children ages 10-18. The program will provide children and youth with immersive STEM-based learning.

Students will have the opportunity to engage in unique national and global STEM opportunities, programs, workshops, and mentorship sessions directed towards the pursuit of post-secondary education and enhanced STEM career aspirations, ultimately pioneering change within the world around them.

Youth will have the opportunity to create exciting and innovative work, collaborate with other bright and like-minded individuals at post-secondary institutions as well as participate in various world-class STEM conferences and leadership events.

Areas of interest and topics to be introduced and taught include:

• Aerospace Engineering• Animation & Media Design• Artificial Intelligence• Biochemistry• Biology• Chemical Engineering• Chemistry• Civil Engineering • Computer Science• Earth Science• Electrical Engineering• Mathematics• Mechanical Engineering• Medical Science Innovation• Neuroscience• Pathology• Robotics and Automation• Coding and Software

Development• Physics, Math and Statistics• Environmental & Architectural

Design• The future of 3D Design • Virtual Reality

Level 1 : Grade 5/Grade 6Level 2 : Grade 7/Grade 8Level 3 : Grade 9/Grade 10Level 4 : Grade 11/Grade 12

Program By:

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Dear Parents or Guardians, STUDENT NAME: ________________________________ STUDENT GRADE:________________________________

The STEM Montessori Academy of Canada would like to thank you for your interest in the 2020 SMAC

Leadership Program.

About the SMAC Leadership Program:

The STEM Montessori Academy of Canada (SMAC) is a registered not for profit regional Science

Technology Engineering and Math (STEM) program open to all students with the mission to deliver top-

notch STEM literacy and application. The SMAC National Leadership Program (SNLP) will specialize in an

advanced and enhanced, bar-none STEM-based educational curriculum that emphasizes the

interconnected subject areas of science, technology, engineering, and math (STEM).

Benefits of the Program:

- Ability to partake in global STEM and Innovation opportunities including conferences, STEM experiences,

camps, campus tours, scholarship opportunities, exchange programs, etc.

- STEM Literacy

- Global Connections

- Leadership Training

- Peer-to-peer learning

- Access to The worlds TOP STEM and Innovation Companies

- Improving their self-confidence, leadership and ownership

- Improving their independence skills for their future path

- Improving their confidence, problem-solving and practical skills

- Giving them connections and allowing for mentorship opportunities with STEM Ambassadors and real

world industries,

Provide students with an ever-expanding skillset that will benefit them in their careers, projects and their

futures.

Schedule:

The 2020/2021 National STEM Leadership Program sessions will take place from February 2021 – June 2021.

Admission Process:

o The admission process at SMAC provides an opportunity to the families to learn about educational

philosophy, curriculum, programs and long-term benefits of learning in an accredited private

school environment. Our goal is to enroll students who will succeed and meet their full potential in

the educational programs we offer.

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Applications and Fees:

Kindly refer to the Registration package for all fee schedules, the enrolment application and other

registration forms.

Key Dates:

Deadline to Apply:

February 3, 2021 Level 1




Last day of selection: February 24, 2021

Deadline to confirm / deny the admission: N/A for February 2021 Admissions

Program Begins:





TERMS AND CONDITIONS

A student child must be entering grade 5 or born in 2010 as a minimum age requirement to be eligible for

entry to the program.

A student may apply if they are homeschooled or enrolled in a public, catholic, independent, private, or

French school.

A student must possess a willingness to learn and excel in STEM disciplines, STEM leadership and express

interest in pursuing STEM based careers.

It is expected that all students enrolled in the program will be in the program for the long haul of its entirety.

Accepted students will automatically be enrolled to the next year level of their program.

As a new program, ALL LEVELS are currently accepting registrations.

There are 4 levels of the program:

- Level 1: Grade 5 & 6




Once the program has commenced, as an exclusive program, once full, registration spots will be available

as students withdraw from the program. Students within the current program will advance through each level

so that students can reap the full benefits of the National STEM leadership experience.

Spots will be allocated on an audition and application basis. Please note all applications for the program will

not guarantee acceptance to the program. Full program details will be provided upon acceptance.

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Once all documentation has been received into the S T E M C a n a d a office it will be processed. The Admissions

department will contact you regarding the status of your application via email by February 5, 2021.

Documentation to submit with registration (Office will make photocopies if needed)

❏ Student’s Birth Certificate (or proof of age) ❏ $59 Non Refundable Registration Fee

Rec'd by: __________________________

Thank you for choosing STEM Montessori Academy of Canada / STEM International Academy of Canada. We trust

your experience will be a memorable and fulfilling one and you will see the standard of excellence resonate at our

institution of learning.

Regards,

The Admissions Team

National STEM Leadership Program **PLEASE RETURN ALL APPLICATIONS TO: Level 1:[email protected] 2:[email protected] 3:[email protected] 4: [email protected]

Forms to be completed and submitted Page #

❏ FORM 1 – REGISTRATION FORM ……………................................................................................................................ 4

❏ FORM 2 – TERMS AND CONDITIONS ………................................................................................................................ 7

❏ FORM 3 – CONSENT AND DISCLOSURE OF PERSONAL INFORMATION.................................................................... 8

❏ FORM 4 – CONSENT TO PHOTOGRAPH AND USE STUDENT LIKENESS ..................................................................................... 9

❏ FORM 5 – LEARNING NEEDS …………………………………………....................................................................................... 10

❏ FORM X – STUDENT MEDICAL INFORMATION (yellow) omitted for virtual sessions........................................................ NIL

❏ FORM 6 – FEE AND PROGRAM SCHEDULE .............................................................................................................. 11

❏ FORM 7 – STUDENT SUBMISSION ………………………....................................................................................................12

❏ FORM 8 – MINOR CHILD WAIVER RELEASE FORM ....................................................................................................14

❏ FORM 9 – DECLARATION …………................................................................................................................................. 17

Payments Options: Please select 1

1) ❏Credit Card Authorization – link will be provided (DO NOT PROVIDE YOUR CARD #)

OR 2) ❏ Money order payable to STEM MONTESSORI ACADEMY OF CANADA in the amount of $59

OR 3) ❏Email Money Transfer (E-Transfers MUST be sent to [email protected]. In the message line of the e

transfer please indicate your name, in addition to your child’s first, last name, Grade and Leve l. __________

* Please note that applications will not be finalized until payment is received. E-transfers are set up for auto-

deposit and will be received immediately. Remember to save all e-payment email confirmations for your

records.

My Child’s Shirt Size: Youth _________ L _________ XL Adult _________ S _________M _________ L _________XL

__________ I am interested in receiving promotional and informational emails about the leadership program.

__________ I am interested in receiving promotional and informational emails about supplementary STEM programs,

STEM camps and other programs with SMAC-SIAC.

mailto:[email protected]

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FORM 1 – REGISTRATION FORM – VIRTUAL LEADERSHIP PROGRAM

NEW STUDENT APPLICATION APPLYING GRADE AND LEVEL __________________________

RETURNING STUDENT ______________________________

APPLICATION FOR THE SMAC NATIONAL LEADERSHIP PROGRAM

_______ Victoria, BC

_______ Vancouver, BC

_______ Calgary, AB

_______ Edmonton, AB

_______ Other (please specify) __________________________

PROGRAM TYPE:

__________ IN PERSON

__________ ONLINE

_______ Toronto, ON

_______ Hamilton, ON

_______ Peel Region, ON

_______ Ottawa, ON

_______ Montreal, QC

__________ HYBRID – IN PERSON AND ONLINE

** Please Note: Due to COVID-19 the 2020/2021 session of the National STEM Leadership Program will begin online in all cities.

We will assess the ability to conduct the program in person as the opportunities arise.

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S T U D E N T I N F O R M A T I O N (please note that all siblings require individual forms one form per registrant)

Student #1 Legal Last Name Legal First & Middle Preferred Name Grade in

Sept Gender

❏ M ❏ F ❏ N

Current School Birthdate (MMM-DD-YYYY) Birth Place Aboriginal

❏ Yes❏ No

Student #2 Legal Last Name Legal First & Middle Preferred Name Grade in Sept

Gender

❏ M ❏ F ❏ N


❏ Yes❏ No

Student #3 Legal Last Name Legal First & Middle Preferred Name Grade in Sept

Gender

❏ M ❏ F ❏ N


❏ Yes❏ No

M A I L I N G A D D R E S S Mailing Name Home Phone Number Language at Home

Address City, Province Postal Code

RESIDENCE OF CHILD (IF DIFFERENT THAN ABOVE) Mailing Name Home Phone Number Language at Home

Address City, Province Postal Code

P A R E N T / G U A R D I A N I N F O R M A T I O N

Mother’s Name Workplace Work Phone

Work Address City/Prov Postal Code

Email Occupation Cell Phone

Father’s Name Workplace Work Phone

Work Address City/Prov Postal Code

Email Occupation Cell Phone

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CUSTODY AND PRIMARY CAREGIVER INFORMATION Primary Caregiver’s Name: Does student live with

both parents? If No, is there a custody agreement in place?

Is this student allowed to be released to non-custodial parent?

Name Contact Phone:

Special Instructions?

NAME OF ADULTS TO WHOM CHILD MAY BE RELEASED TO ( i n a d d i t i o n t o p a r e n t s / g u a r d i a n s ) Name

Relationship to Child Phone Cell Phone

Name Relationship to Child Phone Cell Phone


E M E R G E N C Y C O N T A C T I N F O R M A T I O N ( In a d d i t i o n t o p a r e n t s / g u a r d i a n s ) Name Relationship to Child Phone Cell Phone



S I B L I N G S ( N o t y e t a t t e n d i n g e l e m e n t a r y s c h o o l ) Name Birth Year Name Birth Year

Name Birth Year Name Birth Year

Name Birth Year Name Birth Year

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FORM 2: TERMS AND CONDITIONS FOR 2021 SPRING SESSION - February 2021 – June 2021:

1. By paying for and submitting the PROGRAM REGISTRATINON FEE, it is understood that this becomes a

binding commitment should your chid be selected for the program. This fee is non-refundable whether or not your

child is selected into the program. There are no exceptions to this policy.

2. PROGRAM REGISTRATION FEES cannot be used towards any other program registrations and are non-transferable

from program to program, nor from student to student.

3. All fees paid are NON-REFUNDABLE under any circumstances. This policy includes payments toward: materials and

supplies issued by SMAC, uniforms, meals, activities, program fees, and commitment fees or program deposits.

4. Apparel and/or uniform payments where merchandise are not delivered due to back order or discontinuation will be

issued as a credit and may be used towards other substitute apparel pieces only.

5. If a student is away from an extra-curricular activity due to family travel, illness, or another purpose, program payments

made to that extra-curricular activity will not be refunded as the program fees paid are a commitment to the

registration spot. No exceptions to this policy will be granted.

6. In the event a student is subject to involuntary or voluntary withdrawal, is suspended, expelled, or

otherwise required to leave program for any reason, all fees paid to the program are strictly non-refundable.

7. Application fees are non-refundable under any circumstance, including if your child is denied entrance or

acceptance to the program, nor can they be transferred to another SMAC program including online learning.

8. Any program scholarships cannot be combined with any other discounted offers.

9. An NSF fee of $50 will be applied to all cheques processed with insufficient funds. This NSF MUST be paid

within five (5) business days of the NSF notice. SMAC reserves the right to suspend attendance to students

with delinquent accounts that exceed thirty (30) days, in which the last month’s program deposit will be

applied.

10. SMAC will refund 100% of the program fees paid in the event that the school is not able to offer an advertised

program from the beginning of its commencement. Refunds will NOT be granted if SMAC begins the program

and the registrant chooses to withdraw for any reason.

11. In the event that a student is ineligible for admission prior to the course start date, all fees paid will be

refunded, less the application fee.

12. Any program fees will not be prorated during short academic months due to: December Break, January Break

March Break, nor the end of the school year in June. All program fees must be paid in full each month.

13. In the event in-person classes need to move online for any reason including closure due to public health mandates, the

ongoing pandemic, or mandated closure of our facilities, program fees will be mandatory to be paid for online facilitation

purposes. This is NOT an optional requirement. Payments will cover programming, online facilitators, online infrastructure

costs and program insurance. There are no exceptions to this policy. Failure to pay tuition will result in withdrawal from the

program.

DECLARATION OF INFORMATION: ______ I hereby certify that the above information is complete and correct. ______ I hereby certify that I understand that application fees and program deposits are non-refundable under any

circumstance.

______ I hereby certify that I have read and understand the terms and conditions of application and

enrollment. ______ I have read and understood the application fees, program fees and the withdrawal process.

Parent/Guardian’s Signature: Date:

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FORM 3 – C O N S E N T T O D I S C L O S U R E O F P E R S O N A L I N F O R M A T I O N

I ________________________________, consent to having STEM Montessori Academy of Canada / STEM

International Academy of Canada (SMAC-SIAC) collect personal information that may include the following:

student identification information, birth certificate, legal guardianship, court orders if applicable, parents’

work numbers and e-mail address, behavioural, academic and health information, most recent report card,

emergency contact names and numbers, doctor’s name and number, health insurance number and

any similar information needed for registration.

I further consent to the use and disclosure of information contained in this form and otherwise collected

by or on behalf of SMAC-SIAC for the purpose of establishing, maintaining, and ending the student’s or

parent’s relationship with SMAC-SIAC, for additional purposes identified when or before personal information

is collected, and as otherwise provided in SMAC-SIAC’s Personal Information Privacy Policy. I also consent to

the collection, use and disclosure of such personal information by and to agents, contractors and service

providers of SMAC-SIAC.

This information is required in order to register your child in the SMAC-SIAC National Leadership Program

and assist the school authority (SMAC-SIAC) in making an informed decision as to your child’s suitability

and appropriate placement in the program. It will also allow the school to respond immediately to an

emergency. For more information, the privacy officer for the school is the Director Of Education, who may

be reached at (877) 822-0080 during hours of operation.

Parent/Guardian Name (please print) _______________________________________


ACKNOWLEDGEMENT FOR THE RELEASE AND STORAGE OF PARENT/GUARDIAN PERSONAL

INFORMATION

SMAC-SIAC acknowledges that there will be no disclosure of personal information to unauthorized personnel

or third parties who are not directly involved in school management or the care, supervision, and instruction

of your child(ren) at this school, unless written authorization from a parent or legal guardian is provided to

the school. The school will securely store all digital and hard copy parent and student personal information.

School Phone: (877) 822- 0080

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FO R M 4 – CONSENT TO PHOTOGRAPH AND USE STUDENT LIKENESS

STUDENT’S FULL NAME:

Our Privacy Policy is in place to ensure that we are complying with the legislation. We ask that you read the

following information carefully.

1. There are occasions when the SMAC-SIAC National Leadership Program (SNLP) would like to have contact

with parents to consult them directly about program issues or meetings, or to plan program related

activities. The school will normally make your name, home address and phone number, as well as the child's

name and grade available to program council personnel and the Parent Council. Your personal information

will not be disclosed to anyone for business or commercial purposes. Please sign the statement below to

indicate your wishes.

❏Yes, I permit the release of my personal information for purposes consistent with the above.

❏No, I do not permit the release of my personal information for purposes consistent with the above.


2. It is part of the in our school to allow staff, parents and the media to photograph individual students and

groups of students to commemorate the program and to promote various educational programs, STEM

activities, clubs or events taking place in the program. While photographs and video add to the community

life of our program, they are not required for education purposes. Students' names, photographs and

comments may be published on the school or program website, in marketing materials for the school or

program, in the school or program newsletter, yearbook and, on occasion, the program's annual report, or in

the news media. Please sign the statement below to indicate your wishes.

❏Yes, I permit my child to be involved in such coverage, consistent with the above.

❏No, I do not permit my child to be involved in such coverage, consistent with the above.


3. On our website, www.stemcanada.ca and stemleadershipcanada.com we post the SNLP program

updates, highlights and pictures or video of our students. The SMAC-SIAC may also post videos,

pictures and/or names from time to time. Please sign the statement below to indicate your wishes.

❏Yes I/ ❏No I do not: permit my child’s name ONLY to be allowed on the school/SMAC-SIAC websites

and other promotional or marketing materials.

❏Yes I/ ❏No I do not: permit my child’s picture/video ONLY to be allowed on the school/SMAC-SIAC

websites and other promotional or marketing materials.

❏Yes I/ ❏No I do not: permit my child’s picture/video and name together on the school/SMAC-SIAC


❏Yes I/ ❏No I do not: permit my child’s video image and/or name together on the school/SMAC-SIAC


.


http://www.stemcanada.ca/

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FORM 5 – STUDENT L E A R N I N G N E E D S I N F O R M A T I O N F O R M

Name of Student: _____________________________________________________________________

At SMAC, we take providing children with learning assistance resources in the event they require any such

resources.

Please indicate below if your child has previously received any type of learning assistance in the past and if they

will require any for the upcoming school year.

❏Received One on One Instruction ❏Received Learning Assistance ❏Will Need Learning Assistance

Please Explain Requirements:

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

FOR SMAC OFFICE USE ONLY:

Child requiring accommodation:_____________________________ Date: ______________________________________

Teacher: _______________________________________________ Classroom: __________________________________

Anaphylactic: _________

Teacher’s Recommendation of Special Accommodations:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Director’s Notes:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Authorized By: ___________________________________________ Date: _________________________________________

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FORM 5 – 2020 -2021 PROGRAM FEES

REGISTRATION FEE

A NON REFUNDABLE $59.00 application fee will be charged for each application processed.

DEPOSIT / COMMITMENT FEE

There will be no further session fees required for the February 2021-June 2021 Leadership Program session other

than the standard $59 Application Fee.

PROGRAM FEES

The program fees covers: the cost of all core Leadership programs, University Readiness Program enrollment (first come first serve and based on availability – the program textbooks/resources are NOT included in the fee), monthly SNLP workshops, all exclusive program content, and basic workshop supplies. Program fees do not cover: club resources, virtual learning camps, exchange programs, on-campus learning programs, field trips, food days, application fees, program deposits is any, program apparel, extra online program materials and resources, nor any transportation costs.

PROGRAMS OFFERED TIMES IN-PERSON:

Student Programming: Morning 9:00 am – 12:00 pm (as per time zone)

Parent Programming: Morning 9:00 am – 12:00 pm (as per time zone)

ONLINE:

Student Programming: As p o s t e d a n d a s a v a i l a b l e

PROGRAM FEE SCHEDULE: Sessions are on Saturdays outlined below

Level IN PERSON FEE TIME ONLINE FEE TIME

Grade 5 N/A 9am – noon 1st and 3rd Sat $59 app fee, no additional fees 10 am – noon 1st and 3rd Sat

Grade 6 N/A 9am – noon 1st and 3rd Sat $59 app fee, no additional fees 10 am – noon 1st and 3rd Sat

Grade 7 N/A 9am – noon 2nd and 4th Sat $59 app fee, no additional fees 10 am – noon 1st and 3rd Sat

Grade 8 N/A 9am – noon 2nd and 4th Sat $59 app fee, no additional fees 10 am – noon 1st and 3rd Sat

Grade 9 N/A 9am – noon 3rd and 1st Sat $59 app fee, no additional fees 10 am – noon 2nd and 4th Sat

Grade 10 N/A 9am – noon 3rd and 1st Sat $59 app fee, no additional fees 10 am – noon 2nd and 4th Sat

Grade 11 N/A 9am – noon 4th and 2nd Sat $59 app fee, no additional fees 10 am – noon 2nd and 4th Sat

Grade 12 N/A 9am – noon 4th and 2nd Sat $59 app fee, no additional fees 10 am – noon 2nd and 4th Sat

Bolded session represent in person, plain text represent online session.

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FORM 6 – STUDENT SUBMISSION:

Name of Student: _____________________________________________________________________

This portion of the application allows SMAC-SIAC to assess the aspirations of the student in regards to their

interests in STEM related learning and opportunities. This portion MUST be completed by the student. Please

keep your answers limited to the space provided.

1. Why did you wish to apply for this program?

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

2. What are your views on leadership? How will entry into this program enable you to become a great leader?

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

3. What are your career goals? Where do you see yourself in 10 years?

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

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4. How much exposure have you had to STEM-based activities, courses and/or clubs.

**(Please note, we may choose you because you have had very little exposure, and we may choose you because you have had lots. Please

give us your most honest answer. It is not about your experience, it is about your drive to succeed, and persevere.)

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

5. Why should we choose you for this program?

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

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FORM 7 – MINOR CHILD WAIVER RELEASE:

MINOR CHILD LIABILITY WAIVER AND RELEASE FORM

THIS IS A RELEASE OF LEGAL RIGHTS — READ AND UNDERSTAND BEFORE SIGNING

In order to create a safe and positive environment for the participation of Minor children defined as children

under age 18, in the National STEM Leadership Program, they must always be accompanied and supervised by

an adult.

Parent/Guardian’s must sign a Liability Waiver and Release Form stating they are supervising the child(ren) and

responsible for their actions and safety while participating in the program.

Due to the nature of the program seeing guest facilitators being sourced from all over the world to teach,

facilitate, and mentor participating children, the supervising adult is responsible for the minor child’s safety,

location and virtual activities at all times. Minor children can NOT be left alone while online with a facilitator.

The National STEM Leadership Program is a parent supervised program. __________ (initial)

I hereby certify that I am the adult parent or guardian of ____________________________________, a minor child

under the age of eighteen (18) years, and I am agreeing to take full responsibility for his/her safety and

supervision while participating in the virtual National STEM Leadership Program.

I agree to hold harmless, indemnify and promise not to SMAC-SIAC organization, its volunteers, Board of

Directors, staff, contractors and representatives from and against any present or future claims, cause of action,

loss or liability for injury to person or property, which said minor child may suffer or for which said minor child may

be liable to any other person, related to said minor child’s presence at SMAC-SIAC, resulting from any cause

whatsoever, and regardless of fault.

I understand and acknowledge that I am fully aware of and assume the risks of managing a child in this virtual

environment (including but not limited to the risk of trauma, unwanted contact, cyber stalking, harassment,

emotional or physical trauma, etc).

I understand that SMAC-SIAC shall have no responsibility to pay for medical treatment and related costs if said

minor child is injured while at SMAC-SIAC.

In consideration of the services provided by SMAC-SIAC and my desire for

my child(ren) to participate in activities of the National STEM Leadership Program by SMAC-SIAC, I;

b) agree to provide supervision for my child(ren)

c) acknowledge that

(i) those rules, instructions and directions are intended to promote the safety of both

myself and others;

(ii) my failure or refusal to abide by those rules, instructions and directions can lead to the immediate

revocation of my right to participate in SMAC-SIAC programs without any right to refund of any payments

made;

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d) agree to fully and forever waive, release and discharge the SMAC-SIAC organization, its volunteers, Board of

Directors, staff, contractors and representatives from

any and all claims, actions, causes of action, demands, judgments, damages (including

compensatory, general, special, consequential, exemplary and punitive), liability or

obligations of any nature or kind, whether known at the time I or the Child(ren)’s

Parents leave SMAC-SIAC or which may arise or become known later, which accrue on

account of, or in any way arise out of or in connection with my, the Child(ren)’s Parents’,

or my child(ren)’s participation in activities in SMAC-SIAC;

e) I agree to indemnify and hold the SMAC-SIAC organization, its volunteers, Board of Directors, staff, contractors

and representatives harmless from and against any and all losses, liabilities, claims, obligations, costs, damages,

and/or expenses whatsoever, including, but not limited to, any and all attorneys’ fees, costs, damages and/or

judgments directly or indirectly arising out of, or relating to my and the Child(ren)’s Parents’ acts or omissions

while participating in any activities in SMAC-SIAC;

f) acknowledge that there are foreseen and unforeseen risks associated with participating

in activities in SMAC-SIAC; examples include, but are not limited to, including but not limited to the risk of trauma,

unwanted contact, cyber stalking, harassment, emotional or physical trauma

g) agree to accept and assume all of the risks that accompany participating in activities in

SMAC-SIAC and represent that my, the Child(ren)’s Parents’, and my child(ren)’s participation in activities in

SMAC-SIAC is purely voluntary and we are electing to participate in activities in SMAC-SIAC notwithstanding the

risks; and

h) agree that if my child(ren) are accompanied in SMAC-SIAC by the child(ren)’s caretaker,

which is not myself or my spouse/spousal equivalent, that I and the Child(ren)’s Parents

will ensure that the child(ren)’s caretaker signs the SMAC-SIAC Caretaker release form,

and I and the Child(ren)’s Parents will indemnify and hold the SMAC- SMAC-SIAC organization, its volunteers,

Board of Directors, staff, contractors and representatives harmless from and against any and all losses, liabilities,

claims, obligations, costs, damages, and/or expenses whatsoever, including, but not limited to, any and all

attorneys’ fees, costs, damages and/or judgments directly or indirectly arising out of, or relating to the

child(ren)’s caretaker’s presence and participation in any activities in SMAC-SIAC. __________ (initial)

I expressly agree that this Release Form is intended to be as broad as is permitted by the laws

Of country of Canada and if any portion is held invalid, it is agreed that the balance shall continue in full legal

force and effect. I understand and agree that this Release Form shall be governed by the laws of Canada. I

hereby consent on behalf of myself, the

Child(ren)’s Parents, and my child(ren) for any and all claims related to or arising

out of our participation in activities in the National STEM Leadership Program by SMAC-SIAC.

As myself and my child(ren)’s participation in the National STEM Leadership Program by SMAC-SIAC is voluntary, I

agree to hold harmless and release all liabilities for any suggestive claims brought about by a first, second or third

party individual or organization consisting of volunteers, staff, guest speakers, facilitators, Board of Directors or

parents acting on behalf SMAC-SIAC, or whom which are participating in the National STEM Leadership Program

by SMAC-SIAC.

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I understand that SMAC-SIAC does not provide supervision of any individual within a virtual online environment,

nor for the National STEM Leadership Program participants. _________ (initial)

Knowing the risks described above, I agree, personally and on behalf of the minor child named above, to

assume all the risks and responsibilities surrounding the minor child’s presence at SMAC-SIAC. __________ (initial)

I am at least eighteen years of age and have carefully read and freely signed this Liability Waiver and Release

Form (Minor Child). I understand and agree that no oral or written representations can or will alter the contents of

this document. I agree that this agreement shall be governed by the laws of the country of Canada and will

carry jurisdiction across all provinces and territories. __________ (initial)

I also agree, subject to the terms above, to RELEASE AND HOLD HARMLESS the Released Parties from all liabilities

and claims that arise in any way including but not limited to the risk of trauma, unwanted contact, cyber

stalking, harassment, abuse, emotional or physical trauma that occurs to the minor child during their time at

SMAC-SIAC, while online, and when participating in the National STEM Leadership Program. __________ (initial)

This includes any claim of the minor and any claim arising from the negligence of the Released Parties.

I hereby acknowledge and represent to SMAC-SIAC that I have read and fully understand this Release Form, and

understand that I have limited my rights and the Child(ren)’s Parents’ rights to pursue a claim against the SMAC-

SIAC community by signing this Release Form. I further

represent that I am signing this Release Form freely and voluntarily. __________ (initial)

Parent Signed: ________________________________ Date: __________________________

Parent Name (please print) _________________________________

Child’s Name (please print) _________________________________

Mobile Number: _________________________ Email: __________________________

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FORM 9 – DECLARATION:

PANDEMIC CLOSURES:

In the event of program closures due to a pandemic or natural disaster, our programs will move to online

programming. In such instance, program fees will still apply to cover costs of teachers associated with online

teaching, marking, and lesson planning while partaking in studies online. This is a commitment of enrollment and is

not optional.

ACKNOWLEDGEMENT:

I have read and agree to the terms and fees outlined in this registration document. I am aware of all of the program

fees. _____________ _____________ (initial)

By signing this declaration I acknowledge that:

- All fees paid are non-refundable.

- I am responsible for paying the posted registration fee of $59 to complete the application process.

- I understand that the application fee of $59 is due WITH this application.

- I understand that all fees paid are non-refundable.

- I understand that if my family goes on vacation, tuition payments are still due in full each month and will not be

deferred should I register for an extra program.

- I am aware of the cancellation policies and agree not to dispute or attempt to charge back the

required charges.

- I am aware that my child may not be selected for this program, and the registration fee will not be returned.

- I am aware that no further charges are required for this program from February 2021 – June 2021unless my child

partakes in voluntary extra-curricular program options, in which I am aware there may be a cost associated

with my child’s participation. Such voluntary options may include camps, in-persons sessions, exchange

opportunities and outings.

- I acknowledge that my child must be enrolled in the level that corresponds with their age group. - I acknowledge that I am aware that this program is a parent assisted program and I am responsible for my

child’s supervision and well-being while in session, online, in –person, and within mentorship sessions. While SMAC-SIAC has screened facilitators on a primary level, I understand that some of the facilitators are from post-secondary institutions, or from STEM-based corporations world-wide, and that they may not hold a vulnerable sector clearance check in Canada, nor in their region. My supervision enables me to supervise my child while they are interacting with these individuals.

- I confirm that I have reviewed and signed the Minor Child Waiver and Release Form.

Parent or Guardian 1:

SIGNATURE OF THE PARENT / GUARDIAN (IF UNDER 18) DATE

Parent or Guardian 2:

SIGNATURE OF THE PARENT / GUARDIAN (IF UNDER 18) DATE

Save The Date1516 Clarkson Rd Mississauga, ON (877) 822-0080 Save The Datewww.stemcanada.com [email protected] (877) 822-0080

PROGRAM LOCATIONS:

Ontario:Brampton, ONKitchener, ONMarkham, ONMilton, ONOttawa, ONToronto, ON

Alberta:Calgary, AB

British Columbia:Victoria, BCVancouver, BC

Quebec:Montreal, QC

TOLL-FREE NUMBER: 1-877-822-0080

Ontario:P: (905) 216-6099 P: (416) 244-3719P: (613) 209-2253

Alberta:P: (403) 247-0081

British Columbia:P: (250) 244-8438

Quebec:P: (450) 231-2311

Email: [email protected]: www.stemcanada.ca

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