2020-21 YouLearn Registration Form

Only one (1) registration per school year!
I am registering as: *
Select drop down to see program description.
Full-Time K-9 Student
- completely enrolled at YouLearn for all courses
- not registered at another school
- learners who work primarily from home under the direction of a parent or caring adult who runs the educational programming collaboratively designed by one of our teachers
Full Time 10-12 Student
- enrolled in YouLearn as your main or home school
- taking the majority of courses from YouLearn
- required to work with one of our mentors to plan success toward graduation
Part-Time Cross-Enrolled Student (10-12)
- enrolled at another school, which is your main or home school
- taking the majority of courses from your main school
- taking courses at YouLearn that are needed and/or are not offered at their home school
Adult Non-Graduated
- over 19 years of age and wanting to take course(s) leading toward graduation
Upgrading Graduate (under 19)
- if you were 19 or older on June 30th, of this current year, and if you have graduated from grade 12
- school-age students welcome to take any YouLearn course(s) for free up until they turn 19
- welcome to take previously taken courses to upgrade a mark, and/or new courses to add to your diploma
Graduated Adult (over 19)
- adult students wanting to upgrade or take a high school course
- enrolment in most Math/Science courses are free
- fees apply to all other courses (contact our office for details)
Ashnola at The Crossing
- enrolled in one of our school's unique programs
- required to fill out this registration form in collaboration with one of our teachers
Venture Academy
- enrolled in one of our school's unique programs
- required to fill out this registration form in collaboration with one of Venture Academy's advisors
International Student
- required to be enrolled in a BC International School Program before applying to YouLearn
- please phone our office to begin the enrollment process
Home School Registration

Parents seeking to homeschool their children
- register at a public or independent school
- deliver instruction at home
- exercise complete independence and control over their children’s education
  may use any learning resource of their choice, and
  are not obligated to follow provincially prescribed curriculum
IMPORTANT: Yukon residents must enroll with Aurora Virtual school

This form should only be completed by Aurora Virtual School.
Date

Day Month Year
PERSONAL INFORMATION
Residency *
Please choose International Student HERE if it is applicable.
GENDER *
Date of Birth *

Day-dd Month-mm Year-yyyy
Age
Legal Name *

First Name Middle Name Last Name
Usual Name
(if different from legal name)
Other Name or Aliases
(if different from legal name)
Maiden Name
(if different from legal name)
Have you ever registered with YouLearn before? *

Yes No
If Yes, last year attended: *
Student Phone *
Phone Type *
Other Phone
Phone Type
Student E-mail *

Confirmation Email Primary email for school communication
Physical Address *

Street Address

Street Address Line 2

City Province

Postal Code Country
MAILING ADDRESS *

Same as Physical Address Different
Mailing Address *

Street Address

PO Box

City Province

Postal Code Country

GUARDIANSHIP (UNDER 19)
Who has custody?: *
Parent/Guardian 1 - Name *

First Name Last Name
Please Specify Relationship: *
Are you a legal guardian of the applicant? *

Yes No
Phone Number *
Phone Type *
Parent/Guardian 1 - Email *
Parent/Guardian 2 - Name

First Name Last Name
Please Specify Relationship:
Are you a legal guardian of the applicant?

Yes No
Phone Number
Phone Type
Parent/Guardian 2 - Email
** Custody/Access Issues or Other Legal Alerts/Comments (if any please discuss with the Principal).

EMERGENCY CONTACT
Full Name *

First Name Last Name
RELATIONSHIP: *
Phone Number *
Phone Type *
MEDICAL ALERT INFO
Do you have a medical condition or medical alert that we need to be aware of: *

YES NO
Please list any medications/conditions/alerts: *

SCHOOL HISTORY
ARE YOU CURRENTLY TAKING COURSES AT ANOTHER SCHOOL? *

YES NO
CURRENT SCHOOL ENROLLED AT: *
HAVE YOU GRADUATED FROM HIGH SCHOOL? *

YES NO GED or School Leaving Certificate
IF YES, NAME OF SCHOOL: *
LAST SCHOOL ATTENDED *
LAST GRADE COMPLETED *
In which SCHOOL YEAR *
CITY: *
PROVINCE/COUNTRY *

REQUIRED IDENTIFICATION
Two pieces of ID are required to enroll. *

I understand
Option A - Upload 1 document (both sides):
- Combined BC Service Card (this counts as two pieces of ID)
Option B - Upload two of the following (both sides):
- BC Drivers License
- BC Care Card
- BCID
Option C - Upload one of the above and one of the following (both sides):
- Birth certificate card
- Passport
- Permanent Resident card
Submit ID via:
1. Upload buttons (see below)
2. Email bzakall@sd53.bc.ca SUBJECT LINE: your name/ID
3. Hand deliver ID to office
Do NOT upload your SOCIAL INSURANCE NUMBER!!!!
ID No. 1
ID No. 2
Side 2 of Care Card
ID has been submitted *

Uploaded Emailed Given to Office Staff

Policies and Agreements
IMPORTANT INFORMATION FOR STUDENTS AND PARENTS/GUARDIANS: Please review, authorize and sign all fields below. All information provided on this form is collected under the authority of the School Act, Section 13 and 79 and/or Ministerial Order M152/89. The information provided will be used for educational programs and administration purposes, and when required, may be provided to health services, social services, support services, or the Ministry of Educations data services as outlined in Section 79(2) of the School Act. The authorizations collected on this form will be kept secure and confidential in accordance with the Freedom of Information and Protection of Privacy Act and the School Act. This authorization will be updated on an annual basis for a 12 month term. If you have any questions or concerns regarding this form, please contact your school Principal.
COMMITMENT/AUTHORIZATION
- I understand I can seek help from YouLearn and its teachers at any time while working on my introductory assignment, however, I will not be considered as active in my course(s) until I submit my first assignment
- I understand I will only be registered in a YouLearn program when I have submitted my first introductory assignment.
- I, as a student, am formally commiting to start my courses promptly after enrolling, create and follow a study routine, and establish and maintain a consistent schedule for submitting assignments.
- I understand I may be withdrawn if I do not complete 25% of my course work within the first five months of enrolling.
- I, as a student, intend to complete all of my course(s) within 12 months from my start date, as per YouLearn.ca's expectations.
- I understand that I am required to be informed about and write all required provincial aessessments, graduation assessments and exams.
- I understand I will be notified of continued inactivity via correspondence and/or report cards and if ignored may be withdrawn for ongoing inactivity.
- I understand that the teaching staff of YouLearn.ca plan, oversee and asses my program.
Required *

I have read and agreed to YouLearn's Commitment/Authorization.

STUDENT AGREEMENTS
I have read and agree to:
YouLearn.ca Code of Conduct

Technology: Acceptable Use Agreement

SD53 - Anti-Spam Policy

FIPPA
YouLearn.ca Code of Conduct *
Technology: Acceptable Use Agreement *
SD53-Anti-Spam Policy *
Freedom of Information (FIPPA) *
How did you hear about YouLearn.ca? *
Digital Signature

By completing the following section you are agreeing that your enrollment and course selection information is correct. Further, if you are under 19 you are agreeing that your parents and School of Record counselors/principal have been informed.
Student Signature (Please type in full name) *
Parent/Guardian Signature if student is under 19 *
Comments:
Should be Empty:

Policies and Agreements

Digital Signature