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2023 Student Personal Information Form & Waivers

"*" indicates required fields

1INTRODUCTION

2PASSPORT INFORMATION

3PROGRAM INFORMATION

4ACADEMIC INFORMATION

5DIETARY & MEDICAL INFORMATION

6PARENT/GUARDIAN CONTACT INFORMATION

7CLASSMATE & ROOMMATE REQUESTS

8MEDIA CONSENT AND WAIVER AGREEMENT

9CONFIRM & SUBMIT

Items with an * are required fields.

PERSONAL INFORMATION FORM & WAIVERS

The Personal Information Form & Waivers package must be completed on behalf of every student participating in a Global Summers Academy program. Please allow 10 minutes to fill in all the necessary information.
To complete the package you will need scanned copies (.pdf or .jpeg format) of the following documents available to upload:

Photo and information page of the student’s passport. All students must be in possession of a passport that is valid for at least 6 months beyond the scheduled return date of the program. If the passport is expired, please upload a copy and once the new passport is obtained, please email a copy of the photo and information page to info@globalsummersacademy.com
High school transcript or Credit Counselling Summary
Interim report card if the student is currently taking the pre-requisite course
Individual Education Plan (IEP) or Individual Program Plan (IPP) (if applicable)
Filled out and signed Student Code of Conduct
Filled out and signed Assumption of Risks Waiver

UPDATE: As of May 1, 2023, proof of vaccination is no longer required for Global Summers Academy programs as government travel requirements for Canada and the countries we are travelling to no longer require it. Global Summers Academy will advise if the requirements change.

PASSPORT INFORMATION

Items with an * are required fields.

Student Passport Status:*

I have a passport that is valid for at least 6 months beyond the scheduled return date of my program

My passport is expired/will expire and I will be renewing it. Please upload a copy of the expired passport and once the new passport is obtained, please email a copy of the photo and information page to info@globalsummersacademy.com

I do not have a passport and I will be applying for one

First Name (as on passport)*

Middle Name (as on passport)

Last Name (as on passport)*

Nationality (as on passport)*

Birth Date*

DD slash MM slash YYYY

Sex (as on passport)*

Passport Number*

Date of Issue*

DD slash MM slash YYYY

Date of Expiry*

DD slash MM slash YYYY

Issuing Authority (as on passport)*

Please upload a copy of the photo and information page of your passport. (format .pdf)*

Accepted file types: pdf, Max. file size: 32 MB.

NOTE: TOURIST VISAS FOR STUDENTS TRAVELLING UNDER NON-CANADIAN PASSPORTS

Students travelling with non-Canadian passports must ensure that they meet all eligibility requirements of the countries they are travelling to. It is the responsibility of the student/parents/guardian to ensure that all proper travel documents for all countries visited are obtained well in advance of departure. Please contact your nearest consulate or embassy for details on tourist visa requirements for the countries the student will be visiting.

PROGRAM INFORMATION

Items with an * are required fields.

Program Type*

Grade 9 & 10 Program Choice*

Grade 11 & 12 Program Choice*

Hidden

University Preparatory Program Choice*

ACADEMIC INFORMATION

Items with an * are required fields.

Are you a student in Ontario?*

Yes

What is your OEN number? (numbers only, no dashes or spaces)*

(Your Ontario Education Number (OEN) can be found on your transcript)

STUDENTS OUTSIDE OF ONTARIO
In most cases, students outside the province of Ontario are able to take Ontario curriculum courses and use those credits to apply for university, college, and scholarships. We strongly encourage you to speak with your school Principal or Guidance Department to confirm that the Ontario course will be accepted and the appropriate equivalency granted.

Please upload a copy of your credit counselling summary or high school transcript (this is different from a report card) (mandatory) (format .pdf)*

Accepted file types: pdf, Max. file size: 32 MB.

Please upload a copy of your interim report card if you are currently taking the pre-requisite course.

Accepted file types: pdf, Max. file size: 32 MB.

Pre-requisite course: All students are required to have successfully completed the pre-requisite course prior to the departure date of their program. Please select one of the following options:*

Do you have an Individual Education Plan (IEP) or Individualized Program Plan (IPP)?

Yes

Please upload file

Accepted file types: pdf, Max. file size: 32 MB.

DIETARY & MEDICAL INFORMATION

Items with an * are required fields.

UPDATE: As of May 1, 2023, proof of vaccination is no longer required for Global Summers Academy programs as government travel requirements for Canada and the countries we are travelling to no longer require it. Global Summers Academy will advise if the requirements change.

Hidden

I am currently or will be fully vaccinated against COVID-19 at least 30 days prior to my departure date. (If the answer is no, please contact Global Summers Academy.)

Yes

Hidden

Please upload a copy of the student’s vaccine certificate/proof of full vaccination (mandatory).

Max. file size: 32 MB.

Please provide your provincial health card number.

I am not a resident of Canada.

Do you require vegetarian meals?*

Yes

Do you have any special dietary requirements?*

Yes

If yes, please explain:*

Do you have any allergies?*

Yes

If yes, please explain:*

Do you have any medical conditions that Global Summers Academy should be aware of?*

Yes

If yes, please explain:*

Are you taking any prescription medications?*

Yes

If yes, please explain:*

PARENT/GUARDIAN CONTACT INFORMATION

Items with an * are required fields.

Parent/Guardian 1

Parent/Guardian 1 First Name*

Parent/Guardian 1 Last Name*

Parent/Guardian 1 Cell Phone*

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Email*

Enter Email Re-Confirm Email

Parent/Guardian 1 is an Emergency Contact*

Yes

Parent/Guardian 2

Parent/Guardian 2 Not applicable

Not Applicable

Parent/Guardian 2 First Name*

Parent/Guardian 2 Last Name*

Parent/Guardian 2 Cell Phone*

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Email*

Enter Email Re-Confirm Email

Parent/Guardian 2 is an Emergency Contact*

Yes

CLASSMATE & ROOMMATE REQUESTS

Every effort is made to accommodate most classmate and roommate requests however, requests are not guaranteed.

If possible, I would like to be in the same class with:

If possible, I would like to be in the same room with:

WAIVERS & STUDENT CODE OF CONDUCT

At Global Summers Academy, a high school educational travel program operated by 2769845 Ontario Inc. (“Global Summers Academy”), we provide a rich learning environment where students learn from our teachers and from the guided collaborative work they do in location on our travel education programs. We are proud to share this environment and experience with our students, alumni, family, and friends by featuring students and their work on our websites and in other electronic media, including social media, and in print media, presentations, open houses, advertisements, and the like. To assist in publicizing our programs we request the following consents from our students and their parents or guardians.

PHOTOGRAPHS & RECORDINGS

I, the undersigned, am the parent/legal guardian of the student, understand that during my child’s participation in Global Summers Academy programs, Global Summers Academy may record my child’s image and/or voice, both individually and as part of any group, in any physical or electronic manner including but not limited to still photographs and audio/video recordings, and that Global Summers Academy may make excerpts and compilations of these recordings (the recordings, excerpts and compilations are referred to collectively as “Recordings”) and consent to Global Summers Academy making, creating and retaining such Recordings.

I authorize Global Summers Academy to make, copy, publish, display and otherwise include Recordings of my child in websites and other physical or electronic media (including but not limited to social media, print, radio, television, websites or emails) published or presented by or on behalf of Global Summers Academy, which I understand will be used only in relation to Global Summers Academy programs.

I further understand and agree that Global Summers Academy may decide to use or print all or part of my child’s name in association with Recordings, or may refrain from stating their name altogether.

Photographs & Recordings*

I Agree

I Do Not Agree

Please Initial:*

FURTHER, I AGREE AS FOLLOWS:

(a)The rights I grant to Global Summers Academy herein, as applicable, are non-exclusive, meaning that I may use my child’s Works for any other purposes, and Global Summers Academy is entitled to carry out any of its permitted activities regarding Recordings or Works without payment to me or my child.

(b)Title to all Recordings, photographs, videos or other publications or reproductions made by Global Summers Academy (including Global Summers Academy photographs or recordings of my child or their Works) belongs to and remains with Global Summers Academy. I understand that I am not permitted to copy or publish anything described in the preceding sentence in any manner, including without limitation copying or uploading pictures of my child or their Works taken by Global Summers Academy from any Global Summers Academy website onto any hard drive or other website.

(c) Under no circumstances does Global Summers Academy incur any liability to me or other parties in respect of any use by me or other parties of any material described herein, or any Recordings or copies of my child or their Works made by parties other than Global Summers Academy, that is carried out without the prior written consent of Global Summers Academy, and I release Global Summers Academy in respect of all such liability on behalf of myself and anyone who may claim through me.

(d) Any rights or release granted to or retained by Global Summers Academy may be used by and accrues to the benefit of Global Summers Academy and its parent, related, subsidiary or affiliated entities and any and all of their respective officers, directors, agents and employees and all of the heirs, executors, personal representatives, administrators, successors and assigns of all of the foregoing parties.

ACKNOWLEDGEMENT AND SIGNATURE

I declare and confirm that I am the parent/legal guardian of the student mentioned below and I am the person who completed this form. I have full legal authority to enter into this Media Consent and Waiver Agreement on behalf of myself and on behalf of my child. I have carefully read and understand this Media Consent and Waiver Agreement, including the implications and consequences of executing same. By signing this agreement, I voluntarily accept and agree to be bound by the terms contained herein.

Works*

I Agree

I Do Not Agree

Please Initial:*

WORKS

During my child’s participation in Global Summers Academy programs, my child may create a number of works including but not limited to photographs, videos, drawings, paintings, blogs, papers, emails, texts, and surveys (referred to collectively as the “Works”).

I authorize Global Summers Academy to make, copy, publish, display and otherwise include my child’s Works or any excerpts or compilations made by or on behalf of Global Summers Academy from or including my child’s Works, which may be combined with the Works of my child or Global Summers Academy participants’ or members of the Global Summers Academy’s community in websites and other physical or electronic media (including but not limited to social media, print, radio, television, websites or emails) published or presented by or on behalf of Global Summers Academy, which I understand will be used only in relation to Global Summers Academy programs.

Parent/Guardian Name*

Date*

DD slash MM slash YYYY

Please upload a copy of your signed Student Code of Conduct

Accepted file types: pdf, Max. file size: 32 MB.

Please upload a copy of your signed Assumption of Risks Waiver

Accepted file types: pdf, Max. file size: 32 MB.

CONFIRM & SUBMIT

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1.844.357.2621
1.416.357.2621
3250 Bloor St. West, East Tower,
Suite 600, Toronto, ON, M8X 2X9

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Wednesday, July 26, 2023
WestJet Flight 2644
Depart Toronto 9:00 a.m.
Arrive Liberia 12:19 p.m.

Saturday, August 19, 2023
WestJet Flight 2645
Depart Liberia 1:10 p.m.
Arrive Toronto 8:32 p.m.

Flight details are subject to change by the airlines.

Wednesday, July 5, 2023
WestJet Flight 2644
Depart Toronto 9:00 a.m.
Arrive Liberia 12:19 p.m.

Saturday, July 29, 2023
WestJet Flight 2645
Depart Liberia 1:10 p.m.
Arrive Toronto 8:32 p.m.

Flight details are subject to change by the airlines.

Saturday, July 1, 2023
WestJet Flight 2644
Depart Toronto 9:00 a.m.
Arrive Liberia 12:19 p.m.

Wednesday, July 19, 2023
WestJet Flight 2645
Depart Liberia 1:10 p.m.
Arrive Toronto 8:32 p.m.

Flight details are subject to change by the airlines.

Monday, July 3, 2023
Air Canada Flight 810
Depart Toronto 10:55 p.m.
Arrive Lisbon 11:10 a.m., July 4

Friday, July 28, 2023
Air Canada Flight 821
Depart Barcelona 11:55 a.m.
Arrive Toronto 2:50 p.m.

Flight details are subject to change by the airlines.

Saturday, July 1, 2023
Air Canada Flight 896
Depart Toronto 6:10 p.m.
Arrive Athens 11:00 a.m., July 2

Thursday, July 20, 2023
Air Canada Flight 897
Depart Athens 1:10 p.m.
Arrive Toronto 5:00 p.m.

Flight details are subject to change by the airlines.

Monday, July 3, 2023
Air Canada Flight 872
Depart Toronto 7:30 p.m.
Arrive Paris 8:45 a.m., July 4

Friday, July 28, 2023
Air Canada Flight 815
Depart Nice 1:15 p.m.
Arrive Montreal 4:00 p.m.

Air Canada Flight 425
Depart Montreal 7:00 p.m.
Arrive Toronto 8:23 p.m.

Flight details are subject to change by the airlines.

Saturday, July 1, 2023
Air Canada flight 890
Depart Toronto 8:45 p.m., Arrive Rome 11:15 a.m., July 2

Wednesday, July 26, 2023
Air Canada flight 897
Depart Athens 1:10 p.m., Arrive Toronto 5:00 p.m.

Flight details are subject to change by the airlines.

Friday, July 7, 2023
Air Canada flight 820
Depart Toronto 8:10 p.m., Arrive Barcelona 10:20 a.m., July 8

Tuesday, August 1, 2023
Air Canada flight 891
Depart Rome 11:35 a.m., Arrive Toronto 3:15 p.m.

Flight details are subject to change by the airlines.

Saturday, July 1, 2023
Air Canada flight 820
Depart Toronto 8:10 p.m., Arrive Barcelona 10:20 a.m., July 2

Wednesday July 26, 2023
Air Canada flight 891
Depart Rome 11:35 a.m., Arrive Toronto 3:15 p.m.

Flight details are subject to change by the airlines.

Monday, July 24, 2023
Air Canada flight 896
Depart Toronto 6:10 p.m., Arrive Athens 11:00 a.m., July 25

Friday, August 18, 2023
Air Canada flight 897
Depart Athens 1:10 p.m., Arrive Toronto 5:00 p.m.

Flight details are subject to change by the airlines.

Monday, July 3, 2023
Air Canada flight 896
Depart Toronto 6:10 p.m., Arrive Athens 11:00 a.m., July 4

Friday, July 28, 2023
Air Canada flight 897
Depart Athens 1:10 p.m., Arrive Toronto 5:00 p.m.

Flight details are subject to change by the airlines.

Thursday, June 29, 2023
Air Canada flight 890
Depart Toronto 8:45 p.m., Arrive Rome 11:15 a.m., June 30

Tuesday, July 25, 2023
Air Canada flight 891
Depart Rome 11:35 a.m., Arrive Toronto 3:15 p.m.

Flight details are subject to change by the airlines.

Monday, July 4, 2022
Air Canada Flight 872
Depart Toronto 7:30 p.m.
Arrive Paris 8:45 a.m., July 5

Friday, July 29, 2022
Air Canada Flight 879
Depart Nice 1:15 p.m.
Arrive Montreal 3:55 p.m.

Air Canada Flight 437
Depart Montreal 5:30 p.m.
Arrive Toronto 6:50 p.m.

Flight details are subject to change by the airlines.

Saturday, July 2, 2022
Air Canada Flight 890
Depart Toronto 8:50 p.m.
Arrive Rome 11:15 a.m., July 3

Wednesday, July 27, 2022
Air Canada Flight 897
Depart Athens 12:30 p.m.
Arrive Toronto 4:00 p.m.

Flight details are subject to change by the airlines.

Monday, July 4, 2022
Air Canada Flight 820
Depart Toronto 8:10 p.m.
Arrive Barcelona 10:05 a.m., July 5

Friday, July 29, 2022
Air Canada Flight 891
Depart Rome 11:30 a.m.
Arrive Toronto 2:55 p.m.

Flight details are subject to change by the airlines.

GROUP 1:
Wednesday, July 6, 2022
American Airlines Flight 1169
Depart Toronto 7:00 a.m., Arrive Dallas 9:16 a.m.

American Airlines Flight 1495
Depart Dallas 10:44 a.m., Arrive Liberia 1:47 p.m.

Thursday, July 28, 2022
American Airlines Flight 1238
Depart Liberia 10:49 a.m., Arrive Miami 3:45 p.m.

American Airlines Flight 1246
Depart Miami 8:26 p.m., Arrive Toronto 11:43 p.m.

GROUP 2:
Wednesday, July 6, 2022
American Airlines Flight 2589
Depart Toronto 6:10 a.m., Arrive Miami 9:32 a.m.

American Airlines Flight 1377
Depart Miami 10:38 a.m., Arrive Liberia 11:47 a.m.

Thursday, July 28, 2022
American Airlines Flight 1238
Depart Liberia 10:49 a.m., Arrive Miami 3:45 p.m.

American Airlines Flight 1246
Depart Miami 8:26 p.m., Arrive Toronto 11:43 p.m.

Flight details are subject to change by the airlines.

Wednesday, July 27, 2022
WestJet flight 2644
Depart Toronto 9:15 a.m., Arrive Liberia 12:34 p.m.

Saturday, August 20, 2022
WestJet flight 2645
Depart Liberia 1:30 p.m., Arrive Toronto 8:51 p.m.

Flight details are subject to change by the airlines.

Monday, July 4, 2022
Air Canada Flight 896
Depart Toronto 7:10 p.m.
Arrive Athens 11:40 a.m., July 5

Friday, July 29, 2022
Air Canada Flight 897
Depart Athens 12:45 p.m.
Arrive Toronto 4:30 p.m.

Flight details are subject to change by the airlines.

Monday, July 4, 2022
Air Canada Flight 810
Depart Toronto 11:10 p.m.
Arrive Lisbon 11:10 a.m., July 5

Friday, July 29, 2022
Air Canada Flight 821
Depart Barcelona 11:45 a.m.
Arrive Toronto 2:45 p.m.

Flight details are subject to change by the airlines.

EARLY REGISTRATION EXTENDED TO DECEMBER 7!

Fill in your information below to receive updates on our 2022 programs.

Name*
First Last
Email*

Mark Ives is Academic Director of Global Summers Academy

An Ontario Secondary School educator since 2007 and founding Academic Director and designing architect of Blyth Academy Online, Mr. Ives has also been Academic Director, Program Manager, Photography Teacher or Activity Coordinator on over 25 month-long international student summer school programs. His passion for experiential and life-long learning has led him on many adventures around the globe including Europe, Central America, Caribbean, Oceana and Asia. As Academic Director since 2015, he has mentored over 100 teachers a year and allocated them to student programs in countries in almost every continent in the world. While leading these student programs, he has seen first-hand how beneficial such culturally enriching experiences can be for the development, growth and learning of students. He knows that when students have the opportunity to travel while learning, life skills and strong bonds are developed, and as a result, life-long friendships are formed.

Mr. Ives is a new father and looks forward to international travel in the coming years with his daughter and wife, who is also a teacher.

MARK IVES,
ACADEMIC DIRECTOR

Carolyn Lahoud is the Admissions & Operations Manager of Global Summers Academy.

Carolyn is very passionate about travelling and believes that the core of experiencing the world is to indulge yourself in the sights, smells and feelings of the people and the cultures. She spent four years living in Europe and Southeast Asia, where she was able to realize her passion for travel guidance and education.

With five + years of experience developing her skills and knowledge in the travel industry both locally and abroad, Carolyn has become extremely confident in her ability to successfully coordinate programs for students wishing to study internationally while earning their high school credits.

She is always looking for new and exciting opportunities to enhance her cultural knowledge every day, and wherever her path takes her, she will continue to nourish her soul with all of the beauty that the world has to offer.

CAROLYN LAHOUD,
ADMISSIONS & OPERATIONS MANAGER

Chris Fuller is Principal of Global Summers Academy.

He has 4 degrees from 3 institutions of higher learning and is the first to tell students that “education has no end date”.

An Ontario Secondary School educator since 1989, Mr. Fuller has also been an Academic Director, Program Manager or English Teacher on over 20, month long, international summer school programs. He has expertise and extensive knowledge of “on-location”, experiential teaching practices. Mr. Fuller has traveled with teachers and classes to a great many European and Central American countries where on site teaching took students out of the regular classroom to enrich and “bring to life” the standard course curriculum. He knows this often leads to life changing educational excitement. Continuing to make these international learning opportunities available to as many students as possible is an important priority for him.

Mr. Fuller’s wife and daughter are also teachers with international teaching experience on their resumes. A true family affair.

CHRIS FULLER,
PRINCIPAL

Dina Poulopoulou is the Managing Director of Global Summers Academy.

With nearly two decades of experience managing student travel programs, Dina firmly believes that international travel gives students the opportunity to learn and grow.

Dina has extensive leadership experience in travel operations and logistics management. She keeps her sleeves rolled up and is involved daily in air and land arrangements, hiring and managing onsite program staff, and maintaining supplier relationships around the world.

Dina and her team pride themselves on providing safe, supported, and fun programs for students.

Dina is the proud mom of her teenage son and spends her free time taking courses in a variety of subject areas to always continue learning.

DINA POULOPOULOU,
MANAGING DIRECTOR