2024 Registration Form: Destination Clic

Preparation

Please read the following carefully. This form is only for:

The Destination Clic program (July 1 to July 19, 2024)
Participants in grades 8 to 10

We highly recommend filling out the following form using a computer or a laptop.

If you have any questions regarding the registration process, please do not hesitate to contact us by:

Email at: clic@glendon.yorku.ca
Telephone: 416-487-6708
- Mondays to Fridays from 9:00 AM to 4:00 PM
- Closed for lunch from 12:30 to 1:30 PM

Step 1

Carefully read and complete all sections of the online Destination Clic Program Registration Form and pay the registration fee and security deposit.

Step 2

Complete and mail us a copy of the Mandatory Sensitive Information Form, including the following information:

Social insurance number
Scanned copy of proof of identification with photo of any of the following:
- Health card
- Driver’s license
- Passport
- School ID
- Work ID

> Click here to access the Mandatory Sensitive Information Form (PDF).

Step 3

Optional: if applicable, complete and mail us a copy of the Optional Medical/Accommodation Information Form disclosing:

Proof of accommodation
Proof of medical conditions (seasonal allergies, asthma, diabetes, epilepsy, seizures, heart troubles, etc.)
Proof of prescription medications
Proof of allergies and need for EpiPen
Proof of special diet for medical reasons

Please be reassured that all information will be kept confidential. Our aim in soliciting this information is to ensure that participants are equipped with the supports and resources needed to succeed during their time at Glendon Destination Clic. This information will allow us to provide optimal assistance in the event of an emergency.

> Click here to access the Optional Medical/Accommodation Information Form (PDF).

Step 4

Please send your completed Mandatory Sensitive Information Form and, if applicable, your Optional Medical/Accommodation Information Form to the following address:

Glendon Destination Clic Program
York Hall A112
2275 Bayview Avenue
Toronto, ON M4N 3M6

Note: There’s no necessity for priority postage. We suggest opting for standard postage instead.

Registration Form

RM_Stats
Participant
Agreement
Accommodations
Waiver
Consent
Parent

The following questions aim to collect information specifically about the Destination Clic participant.
A section dedicated to parent/guardian information will be provided at the end of the form. We suggest that the participant and parent/guardian fill out the form together.
First Name^*
Last Name^*
Preferred Name
Gender^*
Personal Pronouns^*
Address^*

Address Line 1 ^*

Address Line 2

City ^*

Province or State ^*

Country ^*

Postal or Zip Code ^*

Email^*
Mobile Number^*
Other Number
Birth Date^*
Have you participated in the Destination Clic program at Glendon Campus before?^*
Yes

No

If yes, in what year did you previously participate?^*

This agreement applies to the French as a First Language Destination Clic Program offered at Glendon Campus, York University for those in grades 8 to 10. The purpose of the Agreement is to ensure a safe and inclusive environment, and a pleasant experience for all participants. We ask for your help in the creation of said environment by agreeing to the conditions outlined below.
> Click here to read the Program Agreement.

I have read, understood, and agree to the Program Agreement Form.^*
Yes

Health Accommodations

Participants are kindly requested to disclose any medical conditions, as well as prescribed medications (including dosage) they are currently taking. This information will be kept confidential and will not negatively impact your application. This will allow us to provide optimal assistance in the event of an emergency.
Additionally, participants are encouraged to identify any supports or accommodations they may require throughout the program. Again, this information will be kept confidential and will not negatively impact your application. Our aim in soliciting this information is simply to ensure that participants are equipped with the supports and resources needed to succeed during their time at Glendon Destination Clic.
Due to its sensitive nature, your medical or accommodation information should be submitted to us via mail using the Optional Medical/Accommodation Information Form.
> Click here to access the Optional Medical/Accommodation Information Form (PDF).

Do you have any conditions that might require additional support or accommodation during the program (related to learning, physical or mental health, etc.)?^*
Yes

No

If yes, kindly provide details regarding your situation and specify any necessary accommodations on your Optional Medical/Accommodation Information Form. All conditions necessitating accommodation must be officially documented (physician’s note, individualized learning/educational plan, etc.). A copy of this documentation must be sent to us via mail to facilitate the necessary arrangements.
Do you have any specific medical conditions? (e.g., seasonal allergies, asthma, diabetes, epilepsy, seizures, heart troubles, etc.)?^*
Yes

No

If yes, please provide more details on your Optional Medical/Accommodation Information Form and mail documented disclosure from your physician or pharmacist of any special requirements or medications, including dosage, frequency, secondary effects, etc. This information will be kept confidential and will allow our team to provide optimal assistance in the event of an emergency.
Are you taking any prescription medications?^*
Yes

No

If yes, please provide more details on your Optional Medical/Accommodation Information Form, including the name of the medication and the proof of prescription (including the prescribed dosage.) This information will be kept confidential and will allow our team to provide optimal assistance in the event of an emergency.
Do you have any serious allergies that may require the use of an epipen?^*
Yes

No

If yes, please provide more details on your Optional Medical/Accommodation Information Form, including any accommodations required, and mail us documented disclosure of your allergy and medical proof of your need for an EpiPen. This information will be kept confidential and will allow our team to provide optimal assistance in the event of an emergency.

Meal Accommodations

Please note that all meals (breakfast, lunch and dinner) are provided in a buffet-style format. Our buffet is designed to accommodate a wide range of dietary restrictions and preferences (examples: vegetarian, vegan, Halal, etc.). Please note that York University is not a nut-free facility.
Note: Regrettably, participants of Glendon Destination Clic are not permitted access to a kitchen under any circumstance. If you require access to a kitchen, kindly consider seeking admission at another institution.

Do you require a special diet for medical reasons?^*
Yes

No

If yes, please provide more details on your Optional Medical/Accommodation Information Form and mail documented disclosure from your physician. All persons requiring dietary accommodations due to medical reasons are required to provide a doctor's note. Participants with dietary restrictions that are not medically documented must personally cover the costs of meal supplements.
Please indicate your dietary preferences^*
I eat meat

I am pescatarian

I am vegetarian

I am vegan

Do you require a special diet for religious reasons?^*
Yes

No

If yes, please provide more details.^*
Do you have any non-life-threatening food allergies or sensitivities?^*
Yes

No

If yes, please provide more details.^*

York University's Health and Safety Requirements

In alignment with the approach to public health guidelines recommended by Ontario’s Chief Medical Officer of Health, York University has adopted a response to COVID-19 that takes a broader approach to community health management.

Masking is strongly recommended.

Vaccination is strongly encouraged.

> Click here to stay up to date with York University’s mandates.

I understand that the recommendations from public health authorities are necessary to maintain a safe and healthy work and learning environment.^*
Yes

Emergency Contacts

To only be contacted in the event of a medical emergency.
Contact Person 1
First Name^*
Last Name^*
Relationship^*
Email^*
Mobile Number^*
Other Number

Contact Person 2
First Name^*
Last Name^*
Relationship^*
Email^*
Mobile Number^*
Other Number

Family Doctor Information

First Name
Last Name
Clinic/Hospital Name
Clinic/Hospital Address

Address Line 1

Address Line 2

City

Province or State

Country

Postal or Zip Code

Phone Number
Other Number

I understand that participation in the Destination Clic Program, hosted by Glendon Continuing Education, both on and off the Glendon Campus of York University, involves a certain degree of risk that could result in injury, death or loss or damage to person or property. After carefully considering the risk involved, I hereby release, hold harmless and waive all claims associated with the scheduled activities of the Destination Clic Program hosted by Glendon Continuing Education, which I may have against Glendon Continuing Education on Glendon Campus of York University, its employees, directors, agents, and volunteers.
I have read and understood the Individual Release and Hold-Harmless Agreement.^*
Yes

Photograph and Video

I hereby grant permission to York University’s Glendon Campus and its representatives to take photographs, videos or recordings of my voice. I further grant to York University’s Glendon Campus and its representatives the right to reproduce, use, exhibit, display, broadcast and distribute these images and recordings in any media now known or later developed for promoting, publicizing or explaining York University’s Glendon Campus and its activities and for administrative, educational or research purposes. Photographs, video images and voice recordings are the property of York University’s Glendon Campus.
Photo and Video Consent^*
Yes

No

I hereby grant permission to York University’s Glendon Campus to use my name with these images and recordings.
Name Consent^*
Yes

No

Future Contact

I give York University’s Glendon Campus permission to contact me about future campus programs, events, and activities.
Contact Consent^*
Yes

No

Parent/Guardian Information

This section must be completed and signed by the parent(s) or legal guardian(s) of all Destination Clic participants under 18 years of age.
Parent/Guardian 1
First Name^*
Last Name^*
Relationship^*
Address

Address Line 1 ^*

Address Line 2

City ^*

Province or State ^*

Country ^*

Postal or Zip Code ^*

Email^*
Mobile Number^*
Other Number

Parent/Guardian 2
First Name
Last Name
Relationship
Address

Address Line 1

Address Line 2

City

Province or State

Country

Postal or Zip Code

Email
Mobile Number
Other Number

Parent/Guardian Authorisation

Most activities in the Destination Clic program are compulsory and supervised. However, some free time has been planned in the schedule. It is expected that all Destination Clic program participants remain on campus at all times.
The Destination Clic program allows for participants to be signed out by a parent or guardian during their free time. We ask that arrangements be made with the Glendon Destination Clic Office a minimum of two business days before the day of sign-out. In addition, the parent or guardian must come to the office during office hours (before 5:00pm) to sign out their child. The participant can sign themself back in upon arrival back on campus by signing in at the office and with the monitor-on-duty.
The Destination Clic program at Glendon Campus, York University prohibits these minors from leaving the campus grounds without the supervision of monitors or teachers. All participants are therefore required to respect the curfew schedule (10:00 PM Sunday to Thursdays and 11:00 PM on Friday and Saturday). The Destination Clic program is not responsible for any events or accidents that may occur off campus.
I have read and understood that my child is not permitted to leave Glendon Campus without the supervision of monitors or teachers, and/or a parent/guardian if advance arrangements have been made with the administrative office, and is therefore expected to respect the curfew schedule (10:00 PM Sunday to Thursday and 11:00 PM on Friday & Saturday).^*
Yes

Registration Fee and Security Deposit Payments

$275.00 non-refundable registration fee +

$200.00 refundable security deposit =
$475.00 in total

> Click here to read about the registration fee and security deposit payments.

I agree to pay $475.00 in total for the Destination Clic program at Glendon Campus of York University.^*
Yes

Name on Credit Card^*

Please Read Below Before Submitting

To complete your registration, please click on the "Proceed to Payment" button below and kindly WAIT to be redirected to the product and billing page.
After completing this form and paying the registration fee and security deposit, please do not forget to the send the:

Mandatory Sensitive Information Form

Optional Medical/Accommodation Information Form

to the following address:

Glendon Destination Clic Program
York Hall A112
2275 Bayview Avenue
Toronto, ON M4N 3M6

We thank you for your interest in the Glendon Destination Clic program and we look forward to meeting you soon!

2024 Registration Form: Destination Clic

Preparation

Step 1

Step 2

Step 3

Step 4

Registration Form

Health Accommodations

Meal Accommodations

York University's Health and Safety Requirements

Emergency Contacts

Family Doctor Information

Photograph and Video

Future Contact

Parent/Guardian Information

Parent/Guardian Authorisation

Registration Fee and Security Deposit Payments

Please Read Below Before Submitting

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