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									Sheridan College Dual Credit Program Application Package 2011-2012
                     Animal Care Program – 2 credits                                                     revised Nov. 2, 2011
To apply for the Dual Credit Program at Sheridan, students must first complete the Registration and Consent Form,
Sheridan Statement of Understanding, Permission for Media Communications and provide to the guidance counsellor.
A complete package includes:
        This page (cover)
        Sheridan Registration and Consent Form
        Sheridan Statement of Understanding
        Permission for Media Communications
        A current student status sheet

 This program is delivered at the Davis campus.
Student Name: ______________________________________________
School Name: _______________________________________                         School Number 905-_______________
Guidance Counsellor Name: _______________________________________________ Ext ___________
The role of the 'dual credit teacher' is to monitor and support the student for the duration of the course, if different from
the 'guidance counsellor'. This teacher will have regular contact by monitoring the student’s progress at Sheridan College
and provide the programming that will supplement the dual credit program.

Dual Credit Teacher Name: ____________________________________________________Ext ___________
Please note: All correspondence related to the status of the application will be sent to the Guidance counsellor.
Upon acceptance, all correspondence related to student progress and activity will be sent to the 'Dual credit
teacher', unless otherwise notified.

                                         Please fax completed application to:
               Namita Sawh, Dual Credit office assistant, fax 905-890-3298; phone 905 890 1010 ext. 2536
        Questions? email Pat Evans, Dual Credit/Experiential Learning Resource Teacher at

    Dual credit courses fill up quickly once course offerings for the following semester are provided to schools.
                                               This is a semester 2 program
For semester 2 program ‘first come - first served’ until available spots are filled; preferably by December 23, 2011

                                            FREEDOM OF INFORMATION
This information is collected under the authority of the Education Act and in compliance with Section 14, Section 32 and
Subsection 29 (1) of the Municipal Freedom of Information and Protection of Privacy Act, and will be used for the
ongoing administration of dual credit programs.

                                     DUAL CREDIT PROGRAM REGISTRATION FORM
                                     Animal Care program – 2 credits          Davis campus
                                        STUDENT INFORMATION
Last Name                                          First Name
City                                               Postal Code
Phone        Home                                  Cell
Emergency                                          Relationship
Contact                                             to Student
Emerg. Phone Day                                   Cell
Date of Birth     dd           mm         yy       Age                             Gender
                                           SCHOOL INFORMATION
Peel Student
                                                          School Name:
Does student have an IEP ?   Check       Yes               No
Dual Credit Teacher                                                 Phone
                                            PROGRAM SELECTION

Semester                  Program                        Schedule              Start             End
   2               Domestic Animal Science          Mondays & Fridays       Week of May 7   Week of June 22
   2                 Animal Grooming                Mondays & Fridays       Week of May 7   Week of June 22

       Student Signature                                                    Date

 Student: _______________________________________
                                  Statement of Understanding Dual Credit Program
   The Dual Credit Program offered at Sheridan College requires me to spend a considerable amount of time working and learning
   outside of my home school as a college/secondary school student. I will represent my school in a responsible manner and in
   accordance with my school's “Code of Conduct”.

 I understand that I must follow all the rules of the Dual Credit Program.

 I will:
  attend regularly and be punctual both at my home school, at Sheridan College and at arranged bus pick-up locations
  if absent from class, report my absence to my instructor/teacher, at both the college and secondary school, before the start of the
  complete all required assignments, tasks and tests
  abide by the rules of Sheridan College including appropriate behaviour and respect for persons and property; Sheridan College
      expectations will be outlined within the first week of the program
  following a review of Sheridan's 'Policies and Procedures Student Manual', on the first day of the program, agree to submit the
      required 'Acknowledgement Form' which is at the end of the manual. This form acknowledges that I agree to listen carefully to
      the instructor's review of the manual, and agree to follow all procedures outlined in that manual.
  be required to provide my own safety shoes and will be required to wear other prescribed clothing for this program (e.g. personal
      protective equipment), as directed by the instructor
  carry my student ID with me and be prepared to present it to the bus driver and/or teachers/college instructors as requested
  abide by the rules of the transportation company and act responsibly on the bus/taxi or my privileges may be withdrawn
  abide by Health and Safety regulations at Sheridan College
  work co-operatively and communicate in a positive manner with all instructors/teachers and peer
 I understand that:
 while at Sheridan College, I will be covered by the Workplace Safety and Insurance Board (WSIB). WSIB coverage is not
      provided while traveling to and from the program
 Sheridan instructors, coordinators, administrators and staff from Sheridan College, Peel DSB, and my secondary school may, as
      required, mutually share information about my behavior, attendance and academic performance or any issues as related to the
      dual credit program. Any or all information may be disclosed to parents or guardian
 if I have an Individual Education Plan my teacher may discuss with my college instructor the necessary accommodations and
      modifications required to allow me to be successful
 if I do not use the busing provided, I will be responsible for arriving punctually at Sheridan College on the arranged dates
 supervision will not be provided on the bus. The bus company can refuse service for inappropriate behaviour.
 if I elect to travel as a passenger in a peer's personal or family vehicle, the district school boards/college provide no insurance
 I must declare to my instructor/teacher any medical condition which may affect my participation in the program. It is strongly
      recommended by the district school board/college that students obtain additional personal medical/accident insurance
 I must provide my instructor/teacher with updated contact or relevant health information should there be any change in the
      information I have provided
 Peel DSB and Sheridan College will not be held responsible for any liability or medical expenses arising out of participating in
      this program

 I understand that failure to comply with the above conditions/rules may result in my removal from the program and loss of
 academic credits.

 __________________________________________                                   ______________
 Student Signature                                                            Date

 _________________________________________                                    ______________
 Parent/Guardian Signature (if student is under 18 yrs. of age)               Date
 One copy of this signed statement is to be retained with the secondary school, one copy is to be retained by the college, one copy to be retained by
 the central board office and one copy is to be distributed to the student or, if the student is under 18 years of age, to the parent/guardian.

                              Permission for Media Communications

I hereby give the Peel District School Board and/or Sheridan College and its employees and agents:

(1)     Permission to photograph, videotape and interview me

(2)     The perpetual and non-exclusive right and licence to use my image, my name and/or a quote from
        me about or a description of my involvement in a work education program in any of the media
        communications (i.e. print, audio, television, social media, online) promoting dual credit and
        experiential learning programs produced by or on behalf of the Peel District School Board and/or
        Sheridan College without payment to me and

(3)     Consent under the Freedom of Information and Protection of Privacy Act to use and disclose my
        image, my name and/or a quote from me about or a description of my participation in any of the
        media communications (i.e. print, audio, television, social media, online) promoting experiential
        learning programs of the Peel District School Board and/or Sheridan College

I release and agree to hold harmless the Peel District School Board and/or Sheridan College, its
employees, representatives, agents and assigns, from all actions claims and demands arising from the
collection, use and disclosure of my image, my name, a quote from me or a description of my
participation in my experiential learning program in the production, reproduction or distribution of any of
the media communications mentioned above.

Date:                                     Name:
                                                                  (please print)


Parent/Guardian's Signature
(if under 18 years of age)

Current Nov.1 2011


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