2025 Language Immersion Program: Summer Registration (Room and Board)

Preparation

Please read the instructions carefully before proceeding.

This form is only for the:

Summer session of the Language Immersion program.
This session is for participants ages 13 to 15.
For participants who require room and board.

This form may take up to 30 minutes to complete. Note that the form does not have an auto-save feature, so be sure to complete it in one session to avoid losing your progress. We highly recommend filling out the following form using a computer or a laptop.

Instructions

Step 1

Carefully read and complete all sections of the online registration form found below, 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 the Glendon Language Immersion. 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:

Language Immersion 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
Agreements
Participant
Accommodations
Waiver
Consent
Parent
Program Agreement

Please read the Program Agreement below. It contains important details about the Language Immersion Program, including policies, expectations, and responsibilities. Reading it is mandatory before registering, so please take a moment to review it carefully.
Click here to read the Program Agreement.
By initialing below, I confirm that I have read and agreed to the Program Agreement above.
Participant's Initials^*
Date^*

Housing and Security Agreement

Please read the Housing and Security Agreements below. This document contains important information about housing policies, safety rules, and your responsibilities while living in residence. Reading it is mandatory before completing your registration. Please review it carefully.
Click here to read the Housing and Security Agreements.
By initialing below, I confirm that I have read and agreed to the Housing and Security Agreements above.
Participant's Initials^*
Date^*

The following questions aim to collect information specifically about the Language Immersion program 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.
I am participating in the^*
French as a Second Language Program (FSL)

English as a Second Language Program (ESL)

Which session would you like to attend?^*
Session 1: June 30 to July 18, 2025

Session 2: July 21 to August 8, 2025

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 Language Immersion program at Glendon Campus before?^*
Yes

No

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

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.
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 Explore 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.^*

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 Language Immersion 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 Language Immersion 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

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 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 program are compulsory and supervised. However, some free time has been planned in the schedule. It is expected that all participants remain on campus at all times.
The program allows for participants to be signed out by a parent or guardian during their free time. We ask that arrangements be made with our 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 Language Immersion 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 Saturday. The 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 Satrday).^*
Yes

Registration Fee and Security Deposit Payments

I agree to pay the fees for the Language Immersion 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:

Language Immersion Program
York Hall A112
2275 Bayview Avenue
Toronto, ON M4N 3M6

We thank you for your interest in our program and we look forward to meeting you soon!

2025 Language Immersion Program: Summer Registration (Room and Board)

Preparation

Instructions

Step 1

Step 2

Step 3

Step 4

Registration Form

Health Accommodations

Meal Accommodations

Emergency Contacts

Family Doctor Information

Future Contact

Parent/Guardian Information

Parent/Guardian Authorisation

Registration Fee and Security Deposit Payments

Please Read Below Before Submitting

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