REGISTER NOW: PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM

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Applying Student's Name:

First

Last

Referral Code, Representative Name or Organization Name (school, association, group)

About the Pre-University STEM Innovation Summer Program:

The Pre-University STEM Innovation Summer Program by the Canadian Institute of STEM Innovation will specialize in an advanced and enhanced, bar-none STEM-based educational curriculum that emphasizes the interconnected subject areas of science, technology, engineering, and math (STEM).

Benefits of the Program:
– Ability to partake in global STEM and Innovation opportunities including conferences, STEM experiences, camps, campus tours, scholarship opportunities, exchange programs, etc.

– STEM Literacy

– Global Connections

– Leadership Training

– Peer-to-peer learning

– Access to The world’s top STEM and Innovation Companies

– Improving their self-confidence, leadership and ownership

– Improving their independence skills for their future path

– Improving their confidence, problem-solving and practical skills

– Giving them connections and allowing for mentorship opportunities with STEM Ambassadors and real-world industries

– Provide students with an ever-expanding skillset that will benefit them in their careers, projects and their futures

Schedule:
The Pre-University STEM Innovation Summer Program by the Canadian Institute of STEM Innovation sessions will take place from July 3 through to August 18, 2023. Course offerings, dates and program availability will vary from location to location.

Registration Process:
Our goal is to enroll students who will succeed and meet their full potential in the educational programs we offer.

Applications and Fees:
Kindly refer to the registration section for all fee schedules, and all of the terms, conditions and waivers.

Registration closes 1 week prior to the commencement of each week.

Programs Dates:

YORK UNIVERSITY:
July 3 – 7, 2023
July 10 – 14, 2023
July 17 – 21, 2023
July 24 – 28, 2023
July 31 – August 4, 2023 1
*August 7 – 11, 2023 – *Day only week

WESTERN UNIVERSITY:
July 10 – 14, 2023
July 17 – 21, 2023
July 24 – 28, 2023
July 31 – August 4, 2023

U ALBERTA:
July 17 – 21, 2023
July 24 – 28, 2023
July 31 – August 4, 2023
August 7 – 11, 2023

UBC:
July 24 – 28, 2023
July 31 – August 4, 2023
August 7 – 11, 2023
August 14-18, 2023

TERMS AND CONDITIONS

A student child must be entering grade 5 or born in 2013 as a minimum age requirement to be eligible for entry to the program.

Any student may apply. International students must be accompanied by a family member.

A student must possess a willingness to learn and excel in STEM disciplines, STEM leadership and express interest in pursuing STEM-based careers.

ALL LOCATONS AND ALL WEEKS are currently accepting registrations. Weeks will be removed from the application as they become full.

Once the program has commenced, as an exclusive program, once full, registration spots will be available as students withdraw from the program. Students within the current program will advance through each level so that students can reap the full benefits of the STEM national leadership experience.

Spots will be allocated on a first come first serve and paid in full basis.

Full program details will be provided upon acceptance.

Once all documentation has been received by our office, it will be processed. The Admissions department will contact you regarding the status of your application within 10 business days.

Documentation to submit with registration (Office will make photocopies if needed)

Student’s birth certificate (or proof of age)
$20 NON REFUNDABLE registration fee

Payment Options (please select one)

Credit Card Authorization – link will be provided (DO NOT PROVIDE YOUR CARD #)
Email Money Transfer (E-Transfers MUST be sent to payments@cisi.tech) *

* In the message line of the e-transfer please indicate your name, in addition to your child’s first, last name, Grade and Level. Please note that applications will not be finalized until payment is received. E-transfers are set up for auto-deposit and will be received immediately. Remember to save all e-payment email confirmations for your records.

Promotional Emails

I am interested in receiving promotional and informational emails about future programs and opportunities.
I am interested in receiving promotional and informational emails about supplementary STEM programs from our program partners.

Thank you for choosing the Canadian institute of STEM Innovation.

We trust your experience will be a memorable and fulfilling one and you will see the standard of excellence resonate at our institution of learning.

Regards,
The Admissions Team
Canadian institute of STEM Innovation.
Pre-University STEM Innovation Summer Program

SECTION 1 – REGISTRATION FORM – Pre-University STEM Innovation Summer Program by the Canadian Institute of STEM Innovation

APPLICATION TYPE:

NEW STUDENT

Applying Student's Grade and Age:

APPLICATION FOR THE Pre University Summer STEM Innovation Program

YORK UNIVERSITY: Toronto, ON
WESTERN UNIVERSITY: London , ON
UNIVERSITY OF BRITISH COLUMBIA Vancouver, BC
UNIVERSITY OF ALBERTA: Edmonton, AB

PROGRAM TYPE:

RESIDENTIAL (Overnight on campus in residence) In-person
DAY PROGRAM (Commuter) In-person

STUDENT INFORMATION

PLEASE NOTE that all siblings require individual forms (one form per registrant)

Student Name

First

Middle

Last

Student Preferred Name

Student Birthdate

Proof of Age

Click or drag a file to this area to upload.

A mandatory requirement of the program is to provide proof of age. This may be any issued ID with a birthdate, or proof of grade enrollment like a report card or school enrollment letter.

Student Grade (at time of registration )

Student Age (at time of registration )

Gender

Male
Female
Prefer not to disclose

School Name

Home (Primary) Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number (Primary Residence)

Secondary Mailing Address (if applicable)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number (Secondary Residence)

Please enter your email, so we can follow up with you.

Language Spoken at Home

PARENT/GUARDIAN INFORMATION

Applying Parent Name (Student's Mother / Father / Guardian)

First

Last

Student's Mother / Father / Guardian Home Phone

Student's Mother / Father / Guardian Home Address (if different from student, if same type "same")

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Student's Mother / Father / Guardian Email

Student's Mother / Father / Guardian Cell Phone

CUSTODY AND PRIMARY CAREGIVER INFORMATION (if different than the applying parent)

Primary Caregiver's Name

First

Last

Primary Caregiver's Phone Number

Does this student live with both parents?

If no, is there a custody agreement in place?

Yes
No
Not applicable

Is this student allowed to be released to non-custodial parent?

Yes
No
Not applicable

Name of Non-Custodial Parent

First

Last

Non-Custodial Parent Phone

Special Instructions / Additional Information

NAME(S) OF ADULT(S) TO WHOM CHILD MAY BE RELEASED (in addition to parents/guardians)

Name of Adult 1

First

Last

Relationship to Child

Phone

Cell Phone

Name of Adult 2

First

Last

Relationship to Child

Phone

Cell Phone

EMERGENCY CONTACT INFORMATION (in addition to parents/guardians)

Name of Emergency Contact 1

First

Last

Relationship to Child

Phone

Cell Phone

Name of Emergency Contact 2

First

Last

Relationship to Child

Phone

Cell Phone

DECLARATION OF INFORMATION:

I hereby certify that the above information is complete and correct.

I hereby certify that I understand that application fees, program deposits and program fees are NON-REFUNDABLE under any circumstance.

I hereby certify that I have read and understood the terms and conditions of application and registration.

I have read and understood the application fees, program fees and the application process

Signature

Printed Parent/Guardian's Name:

Date

SECTION 2 – CONSENT TO DISCLOSURE OF PERSONAL INFORMATION

I consent to have Canadian Institute of STEM Innovation collect personal information that may include the following: student identification information, birth certificate, legal guardianship, court orders if applicable, parents’ work numbers and e-mail address, behavioural, academic and health information, most recent report card, emergency contact names and numbers, doctor’s name and number, health insurance number and any similar information needed for registration.

I further consent to the use and disclosure of information contained in this form and otherwise collected by or on behalf of Canadian Institute of STEM Innovation for the purpose of establishing, maintaining, and ending the student’s or parent’s relationship with Canadian Institute of STEM Innovation, for additional purposes identified when or before personal information is collected, and as otherwise provided in Canadian Institute of STEM Innovation’s Personal Information Privacy Policy. I also consent to the collection, use and disclosure of such personal information by and to agents, contractors and service providers of Canadian Institute of STEM Innovation.

This information is required in order to register your child in the Pre-University STEM Innovation Summer Program and assist the organizer (Canadian Institute of STEM Innovation) in making an informed decision as to your child’s suitability and appropriate placement in the program. It will also allow the organizer to respond immediately to an emergency. For more information, the privacy officer for the school is the Director of Programs, who may be reached at (877) 822-0080 during hours of operation.

ACKNOWLEDGEMENT FOR THE RELEASE AND STORAGE OF PARENT/GUARDIAN PERSONAL INFORMATION

The Canadian Institute of STEM Innovation acknowledges that there will be no disclosure of personal information to unauthorized personnel or third parties who are not directly involved in school management or the care, supervision, and instruction of your child(ren) at this school, unless written authorization from a parent or legal guardian is provided to the school. The school will securely store all digital and hard copy parent and student personal information. School Phone: (877) 822- 0080

Parent Signature

Date

SECTION 3 – HEALTH HISTORY AND PERSONAL INFORMATION

The more information you can provide, the better we can meet the needs of your child. This information will be used by the Day Camp/Childcare Director, and your child’s counselors to support your child. If there is additional information of a sensitive nature, please feel free to send a separate letter marked ‘confidential’ to the attention of the Camp/Childcare Director. Whatever information you send to us will be treated with confidence and respect. We encourage, but do not require, a medical examination.

Is the participant under any form of treatment for an illness, condition or injury?

Does your child require 1-1 support?

Does your child have any medical or behavioural conditions that we should be aware of?

Does your child use a puffer?

Does your child wear Medic-Alert Bracelet?

Does your child carries an epi-pen?

Anaphylactic Notice

Is there anything else about your camper’s medical history we should know about?

Medical Emergencies

In the case of an accident, injury, or sickness involving the participant, and immediate communication with a designated contact by for The Canadian Institute of STEM Innovation (CISI) is not possible, I hereby empower and permit CISI staff to procure appropriate medical treatment and authorize on the participant’s behalf all procedures. This includes, but is not limited to, admittance to an emergency facility, hospital, and treatment within it, ordering of x-rays, tests or treatments, injections, anesthesia, and/or surgery, as deemed necessary by the attending medical professional(s). I consent to not hold CISI accountable for any costs or injuries resulting from an emergency situation.

SECTION 4: STUDENT LEARNING NEEDS INFORMATION

At Canadian Institute of STEM Innovation, we provide children with learning assistance resources in the event they require any such resources.

Please indicate below if your child has previously received any type of learning assistance in the past and if they will require any for the upcoming school year.

Received one on one instruction
Received learning assistance
Will need learning assistance
My child does not require learning assistance

Please indicate below if your child has any learning disabilities or behavioural issues or concerns

Attention Deficit Disorder (ADD)
Attention-deficit/hyperactivity disorder (ADHD)
Oppositional defiant disorder (ODD)
High-Functioning Autism
Learning Disability (Dyslexia, Dysgraphia, Dyscalculia, Auditory processing disorder, Language processing disorder, Nonverbal learning disabilities, Visual perceptual/visual motor deficit)
Other (please explain below)

Please Explain Requirements:

SECTION 5: CONSENT TO PHOTOGRAPH AND USE STUDENT LIKENESS

Student's Name:

First

Last

Our Privacy Policy is in place to ensure that we are complying with the legislation. We ask that you read the following information carefully.

I understand

There are occasions when the Pre University Summer STEM Innovation Program would like to have contact with parents to consult them directly about program issues or meetings, or to plan program-related activities. Canadian Institute of STEM Innovation will normally take your name, home address and phone number, as well as the child’s name and grade available to program council personnel and the Parent Council. Your personal information will not be disclosed to anyone for business or commercial purposes.

Please sign the statement below to indicate your wishes.

Yes, I permit the release of my personal information for purposes consistent with the above.
No, I do not permit the release of my personal information for purposes consistent with the above.

Signature

Parent/Guardian's Signature Print

Date

It is part of our school to allow staff, parents and the media to photograph individual students and groups of students to commemorate the program and to promote various educational programs, STEM activities, clubs or events taking place in the program. While photographs and video add to the community life of our program, they are not required for education purposes. Students’ names, photographs and comments may be published on the school or program website, in marketing materials for the school or program, in the school or program newsletter, yearbook and, on occasion, the program’s annual report, or in the news media.

Please sign the statement below to indicate your wishes.

Yes, I permit my child to be involved in such coverage, consistent with the above.
No, I do not permit my child to be involved in such coverage, consistent with the above.

Parent/Guardian's Signature

Date

On our website and the websites of our program partners post program updates, highlights and pictures or video of our participants and students. The Canadian Institute of STEM Innovation may also post videos, pictures and/or names from time to time.

Please sign the statement below to indicate your wishes.

Yes, I permit my child’s NAME ONLY to be allowed on the program/school/Canadian Institute of STEM Innovation websites and other promotional or marketing materials
Yes, I permit my child’s PICTURE/VIDEO ONLY (no name) to be allowed on the program/school/Canadian Institute of STEM Innovation websites and other promotional or marketing materials.
Yes, I permit my child’s PICTURE AND NAME TOGETHER on the program/school/Canadian Institute of STEM Innovation websites and other promotional or marketing materials.
Yes, I permit my child’s VIDEO IMAGE AND/OR NAME TOGETHER on the program/school/Canadian Institute of STEM Innovation websites and other promotional or marketing materials.
No, I DO NOT PERMIT my child’s name, picture, and/or video image on the program/school/Canadian Institute of STEM Innovation websites and other promotional or marketing materials.

Signature

Parent/Guardian's Signature Print

Date

Name of Student

First

Last

SECTION 6: PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM SCHEDULE AND FEES

REGISTRATION FEE

A NON-REFUNDABLE $20.00 application fee will be charged for each application processed.

* Balance due by June 20, 2023 for weeks 1 to 4. July 3 for weeks 5 to 7. Registrations after June 20, 2023 are required to be paid in full.

CONFIRMATION, PAYMENT, CANCELLATIONS AND REFUND POLICY

Once registered, you will receive an auto response to confirm your registration. You will receive confirmation from a program coordinator within two weeks of for The Canadian Institute of STEM Innovation (CISI) receiving your completed forms and deposit. If you have not received your confirmation of registration within two weeks, please contact our Program Registration Office at programs@cisi.tech or call 877 822 0080 to ensure your registration was received.

The $20 application fee, along with a $250 non refundable deposit is required to be submitted with the application in order to hold a program spot and process an application. Space is limited. Full payment is required in order to guarantee a program spot. All outstanding balances must be paid in full by June 20, 2023 for weeks 1, 2, 3, 4; and by July 3 for weeks 5, 6 and 7. Any registrations submitted after the indicated deadlines must be paid in full at the time of registration. Payments can be made via PayPal, Interac e transfer or Paysend.

If full payment is not received by our office prior to the program payment deadlines of June 20 for weeks 1-4 or by July 3, 2023 for weeks 5-7, CISI reserves the right to cancel the registration without notice, and the $20 application fee along with the non refundable $250 deposit will be forfeited as a cancellation charge. Any requests for cancellation for any reason must be made in writing no later than June 15, 2023. Requests for cancellations must be made in writing via email to programs@cisi.tech.

Cancellation requests must be received at least 21 days before the start of the program week. A cancellation is subject to a program credit valid for 1 year only. No monetary refunds will be granted. Program credits may be used across all programming including weekend classes, other program opportunities, service requests, workshops, resource kits, and general course registration throughout the year. A full list of programs eligible for the credit application will be emailed to the registrant.

Cancellation requests that are received less than 20 days prior to the start of the program will not qualify for a program credit under any circumstances and the deposit and application fee will be forfeited. For cancellations due to medical reasons, a program credit for 1 year will apply.

I understand that registration is not complete until I have made the application fee payment and it is received by Canadian Institute of STEM Innovation.

Yes, I understand

Parent/Guardian's Signature and Acknowledgement of Registration Terms

Parent or Guardian Print

Date

Flexible Residential Program Options (OVERNIGHT RESIDENCE) – Students may register for 1,2,3,4 or 5 week stays and program choices

Card Layout for Residential Options

1 Week Residence Program – $1699

1 STEM Stream
1 Week of Programming
On Campus Stay
Awards Gala & STREAM Certificate
All Class Resources
Food, Snacks & Activities

4 Week Residence Program – $6396

4 STEM Streams
4 Weeks of Programming
On Campus Stay
Awards Gala & STREAM Certificate
All Class Resources
Food, Snacks & Activities

2 Week Residence Program – $3199

2 STEM Streams
2 Weeks of Programming
On Campus Stay
Awards Gala & STREAM Certificate
All Class Resources
Food, Snacks & Activities

5 Week Residence Program – $7995

5 STEM Streams
5 Weeks of Programming
On Campus Stay
Awards Gala & STREAM Certificate
All Class Resources
Food, Snacks & Activities

3 Week Residence Program – $4799

3 STEM Streams
3 Weeks of Programming
On Campus Stay
Awards Gala & STREAM Certificate
All Class Resources
Food, Snacks & Activities

6 Week Residence Program – $9595

6 STEM Streams
6 Weeks of Programming
On Campus Stay
Awards Gala & STREAM Certificate
All Class Resources
Food, Snacks & Activities

Residential Stream Daily Schedule

Day 1

9am – 11 am	Welcome / Activities / Room Allocations
11:00 am – 12:15 pm	Welcome Meeting, Team Building and Lunch
12:15 pm – 1:30pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 4:00 pm	Afternoon Snack, welcome Team Building
4:00 pm – 4: 30	Evening Activity Prep
4:30 pm – 8:30 pm	Afternoon / Evening activities begin

* Dinner scheduled between 5:30 and 6:30 pm

Day 2 & 3

7:00 – 8:00 am	Morning Activity (optional) Painting, Yoga, Pilates or Hike
7:30- 8:30 am	Morning Breakfast
8:45 am – 10:00 am	Session 1
10:05 am – 11:20 am	Session 2
11:20 am – 12:10 pm	Lunch
12:10 pm – 1:25 pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 4 pm	Afternoon Snack, Free Time, Evening Activity Prep
4:00 pm – 8:30 pm	Afternoon / Evening Activities Begin

* Dinner scheduled between 5:30 and 6:30 pm

Day 4

7:00 – 8:00 am	Morning Activity (optional) Painting, Yoga, Pilates or Hike
7:30- 8:30 am	Morning Breakfast
8:45 am – 10:00 am	Session 1
10:05 am – 11:20 am	Session 2
11:20 am – 12:10 pm	Lunch
12:10 pm – 1:25 pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 4:30 pm	Afternoon Snack, Free Time, Evening Activity Prep
4:30 pm – 5:30 pm	Networking Hour
5:30 pm – 8:30 pm	AWARDS GALA Enjoy a delicious buffet dinner and awards and recognition gala.

Day 5

7:00 – 8:00 am	Morning Activity (optional) Painting, Yoga, Pilates or Hike
7:30- 8:30 am	Morning Breakfast
8:45 am – 10:00 am	Session 1
10:05 am – 11:20 am	Session 2
11:20 am – 12:10 pm	Lunch
12:10 pm – 1:25 pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 3:15 pm	Pack up
3:30pm	Depart

Flexible Day Program Options

Students will commute to and from home each day. The program runs daily from 8:45 am to 4 pm)

Card Layout for Day Options

1 Week Day Program – $1299

1 STEM Stream
1 Week of Programming
Day Program 9am – 4pm
Awards Gala & STREAM Certificate
All Class Resources
Lunch, Snacks

4 Week Day Program – $4696

4 STEM Streams
4 Weeks of Programming
Day Program 9am – 4pm
Awards Gala & STREAM Certificate
All Class Resources
Lunch, Snacks

2 Week Day Program – $2398

2 STEM Streams
2 Weeks of Programming
Day Program 9am – 4pm
Awards Gala & STREAM Certificate
All Class Resources
Lunch, Snacks

5 Week Day Program – $5898

5 STEM Streams
5 Weeks of Programming
Day Program 9am – 4pm
Awards Gala & STREAM Certificate
All Class Resources
Lunch, Snacks

3 Week Day Program – $3597

3 STEM Streams
3 Weeks of Programming
Day Program 9am – 4pm
Awards Gala & STREAM Certificate
All Class Resources
Lunch, Snacks

6 Week Day Program – $7094

6 STEM Streams
6 Weeks of Programming
Day Program 9am – 4pm
Awards Gala & STREAM Certificate
All Class Resources
Lunch, Snacks

Day Stream Daily Schedule

Day 1

9am	Arrivals – Welcome / Activities
11:00 am – 12:15 pm	Welcome Meeting, Team Building and Lunch
12:15 pm – 1:30pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 3:30 pm	Afternoon Snack, welcome Team Building
3:30pm	Depart

Day 2-3

8:30 am	Arrival
8:45 am – 10:00 am	Session 1
10:05 am – 11:20 am	Session 2
11:20 am – 12:10 pm	Lunch
12:10 pm – 1:25 pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 3:30 pm	Afternoon snack, Activities
3:30pm	Depart

Day 4 *Extended Day for Day Program Students to Accommodate the Awards Gala

8:30 am	Arrival
8:45 am – 10:00 am	Session 1
10:05 am – 11:20 am	Session 2
11:20 am – 12:10 pm	Lunch
12:10 pm – 1:25 pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 4:30 pm	Afternoon Snack, Free Time, Evening Activity Prep
4:30pm – 5:30pm	Networking Hour
5:30pm – 8:30pm	AWARDS GALA Enjoy a delicious buffet dinner and awards and recognition gala.

Day 5

8:30 am	Arrival
8:45 am – 10:00 am	Session 1
10:05 am – 11:20 am	Session 2
11:20 am – 12:10 pm	Lunch
12:10 pm – 1:25 pm	Session 3
1:30 pm – 2:45 pm	Session 4
2:45 pm – 3:15 pm	Goodbye Rally
3:30pm	Depart

SECTION 7: PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM COURSE & STREAM SELECTION – 2023

Choose Your Program Level:

Elementary / Middle School: Ages 10 – 13 (Grade 5-8)
High School: Ages 14 – 17 (Grade 9-11)

Choose if you are taking the "Residential Stream" (Overnight Residence) or the "Day Stream" (Daily Commuter). ** Different fee applies (please check the fee chart).

Residential Stream (Overnight Residence)
Day Stream (Commuter)

APPLICATION FEE: There is a non-refundable deposit of $250 due with the application. If payment is made in full, a discount of $50 off the program fee will be applied and the $20 application fee will be waived for a total savings of $70. Are you paying in full?

Yes, I am paying in full. (Please apply the $50 discount and waive my application fee) – $ 0.00
No I am not paying the full balance. I am including a non-refundable deposit of $250 plus the $20 application fee. – $ 20.00

COURSE SELECTION: CHOOSE YOUR STEM INNOVATION STREAM

Choose the program location and then the STEM Innovation stream you are interested in. (Only one STEM stream can be taken each week. To review the program brochure, click here)

Week 1: July 3 – 7, 2023

University location options for Week 1:

York University (Toronto, ON)

Week 2: July 10 – 14, 2023

University Options for Week 2:

York University – Toronto (ON)
Western University – London (ON)

Week 3 July 17 – 21, 2023

University options for Week 3:

York University
Western University
University of Alberta

Week 4 July 24 – 28 2023

University options for Week 4:

York University – Toronto (ON)
Western University – London (ON)
University of Alberta – Edmonton (AB)
University of British Columbia – Vancouver (BC)

Week 5 July 31 – Aug 4 2023

University options for Week 5:

York University – Toronto (ON)
Western University – London (ON)
University of Alberta – Edmonton (AB)
University of British Columbia – Vancouver (BC)

Week 6 Aug 7 – 11 2023

Week 7 Aug 14 – 18 2023

University options for Week 7:

University of British Columbia – Vancouver (BC)

EXTRA OPTIONS:

If there is enough interest each week, we will provide transportation at a cost of $75 per child. The fee will include 2 way transportation to and from your city listed below from a central pick up location from your city center. . Please indicate your transportation request should you be interested in a transportation option. Transportation is NOT guaranteed and is based on interest. Please selected an option of interest

I do not require transportation
Yes I would like to explore transportation

Total

$ 0.00

SECTION 8: CONFIRMATION OF PAYMENT

After making your payment, please fill the following information regarding the payment made

* PayPal via Credit Card:
(IMPORTANT: Do NOT send us your payment via PayPal without receiving the link. Please note a one time $5.00 charge plus a 2.5% processing fee will be added to the total. By selecting this method an email link will be sent to you to complete payment. (Example $1699 = $1,746.46 if paying via PayPal)
Program spots are not guaranteed until your payment has cleared PayPal, which can take up to 1 week.

*Interac E-Transfer (preferred method of payment)
** If you are sending payment via Interac E-Transfer or PaySend please ensure you put your child’s name, your email address and phone number in the message box of the transaction

*Setting Up a Donation Form to Fundraise the program fees
** In order to be eligible to set up a donation form to fundraise the program fee, a student must have paid the initial deposit of $250 plus the $20 application fee. To review the fundraising program, click here.

Payment type

Interac E-transfer – Payments should be sent to payments@cisi.tech
PayPal Credit Card – Do NOT send your credit card information. A link will be sent to your email.
PaySend – Payments should be sent to payments@cisi.tech

Date of Payment

Payment confirmation number:

Name of Student

Payment Amount

Minimum Payment Required With Submission: $270.00 ($250 deposit and $20 Application fee.)

Fundraising Page Request:

I have paid the $270 deposit. We would like to set up a fundraising page

*By submitting the form, I confirm that I have made payment according to my payment option choice. (Partial of Full Payment)

Signature

SECTION 9: TERMS & CONDITIONS, WAIVERS

PLEASE SIGN IN THE SIGNATURE BOX FOR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE CODE OF CONDUCT

CODE OF CONDUCT

The well-being and safety of every participant is the primary concern for The Canadian Institute of STEM Innovation (CISI). Every participant must acknowledge their personal duty to understand and adhere to all safety regulations and other guidelines set by CISI staff. I hereby consent that any conduct by the participant that endangers themselves or others may lead to their immediate removal from the program. Furthermore, if the participant is expelled from the program, I accept responsibility for any costs resulting from such expulsion. I also confirm and accept that no refund will be provided in case of voluntary withdrawal or expulsion of the participant before the conclusion of a program session. To ensure the safety and welfare of all participants, CISI retains the right to modify the program at any time without prior notice or compensation to the participant.

View code of conduct here

Signature Code of Conduct

PLEASE SIGN IN THE SIGNATURE BOX FOR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE CONFIRMATION, PAYMENT, CANCELLATIONS AND REFUNDS POLICY

CONFIRMATION, PAYMENT, CANCELLATIONS AND REFUNDS

Once registered, you will receive an auto response to confirm your registration. You will receive confirmation from a program coordinator within two weeks of for The Canadian Institute of STEM Innovation (CISI) receiving your completed forms and deposit. If you have not received your confirmation of registration within two weeks, please contact our Program Registration Office at programs@cisi.tech or call 877 822 0080 to ensure your registration was received.

The $20 application fee, along with a $250 non refundable deposit is required to be submitted with the application in order to hold a program spot and process an application. Space is limited. Full payment is required in order to guarantee a program spot. All outstanding balances must be paid in full by June 20, 2023 for weeks 1, 2, 3, 4; and by July 3 for weeks 5, 6 and 7. Any registrations submitted after the indicated deadlines must be paid in full at the time of registration. Payments can be made via PayPal, Interac e transfer or Paysend.

If full payment is not received by our office prior to the program payment deadlines of June 20 for weeks 1-4 or by July 3, 2023 for weeks 5-7, CISI reserves the right to cancel the registration without notice, and the $20 application fee along with the non refundable $250 deposit will be forfeited as a cancellation charge. Any requests for cancellation for any reason must be made in writing no later than June 15, 2023. Requests for cancellations must be made in writing via email to programs@cisi.tech.

Cancellation requests must be received at least 21 days before the start of the program week. A cancellation is subject to a program credit valid for 1 year only. No monetary refunds will be granted. Program credits may be used across all programming including weekend classes, other program opportunities, service requests, workshops, resource kits, and general course registration throughout the year. A full list of programs eligible for the credit application will be emailed to the registrant.

Cancellation requests that are received less than 20 days prior to the start of the program will not qualify for a program credit under any circumstances and the deposit and application fee will be forfeited. For cancellations due to medical reasons, a program credit for 1 year will apply.

View confirmation, payment, cancellations, and refunds here

Signature – ACKNOWLEDGEMENT AND ACCEPTANCE OF THE CONFIRMATION, PAYMENT, CANCELLATIONS AND REFUNDS POLICY

PLEASE SIGN IN THE SIGNATURE BOX FOR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE DEDICATION TO PRIVACY POLICY

COMMITMENT TO PRIVACY

The Canadian Institute of STEM Innovation (CISI) is devoted to preserving personal information by implementing conscientious information management practices. We gather and utilize data you provide voluntarily when you engage with or register for a CISI program. Our aim is to better cater to your service requirements, create a secure environment, employ the information for statistical and assessment objectives, keep you informed about the program you’re enrolled in, and comply with governmental and regulatory mandates. Occasionally, you may receive updates about other CISI programs, services, and opportunities that may be beneficial to you. For more details on our dedication to privacy, or if you prefer not to receive such communications from CISI, kindly visit our website or contact the CISI Program Registration Office.

View dedication to privacy here

Signature – PRIVACY POLICY

PLEASE SIGN IN THE SIGNATURE BOX FOR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE ASSUMPTION OF RISK AND INDEMNIFYING RELEASE

ASSUMPTION OF RISK AND INDEMNIFYING RELEASE

While for The Canadian Institute of STEM Innovation (CISI) staff and instructors will make every reasonable effort to minimize exposure to known risks associated with each Registrant’s participation in a CISI program , I hereby acknowledge that I and/or my child if I am registering on his/her behalf (collectively, the “Registrant”) may be required, depending on the nature of the Program, to participate in various physical activities that may involve risk of injury. In this regard, I agree that I have provided (if required) a complete and accurate health history and hereby permit the Registrant to participate in the full range of Program activities, except as specifically noted by me in the health information section of the Program registration (where applicable).

I, the undersigned, as a participant or as a parent/guardian of a participant in a CISI Program, hereby understand and accept that participation in a pre-university program taking place on a publicly accessible university campus by persons 18 years of age and older and who are not associated with the program involves certain inherent risks. These risks include, but are not limited to, unwanted contact, abuse, personal harm, verbal distress, physical injury, emotional distress, and/or property damage. In consideration of the opportunity to participate in the program, I freely and willingly assume all such risks and hazards, both known and unknown, associated with participation in the program and acknowledge that the program takes place on a university campus.

In consideration for the Registrant’s opportunity to participate in a CISI Program, the receipt and sufficiency of which is hereby acknowledged, I hereby release and forever discharge The Canadian Institute of STEM Innovation (CISI), STEM Canada, its partners, all staff members, stakeholders, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns, York University, Western University, The University of Alberta, and The University of British Columbia, from any and all liability for damages sustained in consequence of loss, injury or damage to the Registrant, and from all other actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss or damages to any person or property arising out of or connected with preparation for, or participation in, the Program.

To the fullest extent permitted by law, I hereby release, indemnify, and hold harmless The Canadian Institute of STEM Innovation (CISI), STEM Canada, its partners, all staff members, stakeholders, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns, York University, Western University, The University of Alberta, and The University of British Columbia from any and all claims, demands, suits, costs, expenses, liabilities, and damages (including attorney’s fees) arising out of or in connection with any injury, illness, death, loss, or damage to person or property which I or my child(ren) may suffer or incur as a result of, or in connection with participation in the program.

I confirm that I have read and understood this Assumption of Risk and Indemnification Release before signing it and I am aware that by signing it, I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators and assigns may have against The Canadian Institute of STEM Innovation (CISI), STEM Canada, its partners, all staff members, stakeholders, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns, York University, Western University, The University of Alberta, and The University of British Columbia

View assumption of risk and indemnifying release here

Signature – ACCEPTANCE OF THE ASSUMPTION OF RISK AND INDEMNIFYING RELEASE

PLEASE SIGN IN THE SIGNATURE BOX FOR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE DISCLAIMER

DISCLAIMER

All programs are subject to alteration, changes or cancellation due to change in resources, insufficient enrolment, staff illness or other unforeseen circumstances that are detrimental to the planned functioning of the program. Transportation services if available, will be provided by a third party via Great Canadian Coaches or a similar vendor and is not guaranteed and based on interest. No monies will be collected up front for transportation. It is recommended that registrants do not rely on transportation services in order to make it to and from the program..

View disclaimer here

Signature

PLEASE SIGN IN THE SIGNATURE BOX FOR ACKNOWLEDGEMENT AND ACCEPTANCE OF THE CONSENT FOR PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM STUDY

CONSENT FOR CAMP STUDY

For The Canadian Institute of STEM Innovation (CISI) values the insights of our campers and we greatly value feedback from our youth participants so that we can enhance our leadership programs together. While at camp, campers may be invited to fill out a questionnaire and/or participate in an interview about their health, leadership capabilities, and experiences at camp. We are evaluating the program, not the camper. Participation is entirely optional. Any information provided by campers will not be sold under any circumstances. The findings will be compiled and disseminated among camp staff and within CISI. Some results may be shared in summary form with program donors and the public, but camper names and identifying information will never be disclosed. If you require further information or clarification, please get in touch with us.

View consent for camp study here

Signature – CONSENT FOR PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM STUDY

PLEASE INITIAL ACKNOWLEDGEMENT OF LOST AND FOUND DISCLAIMER

LOST AND FOUND DISCLAIMER

Our staff will do their utmost to ensure that campers return home with all their personal belongings, however, for The Canadian Institute of STEM Innovation (CISI) cannot be held accountable for any lost or damaged items. We recommend that camper families ensure that valuable items, including electronics and toys, are kept at home and that campers wear clothes suitable for outdoor activities and potential messiness!

View lost and found disclaimer here

Signature = LOST AND FOUND DISCLAIMER

ACKNOWLEDGEMENTS, TERMS AND CONDITIONS

1. By paying for and submitting a deposit and / or the PROGRAM REGISTRATION FEE, it is understood that this becomes a binding commitment for the program. This fee is non-refundable whether or not your child attends the program. There are no exceptions to this policy.

2. PROGRAM REGISTRATION FEES cannot be used towards any other program registrations and are non-transferable from program to program, nor from student to student unless written permission is granted or a program credit is issued and the reasoning is within the guidelines of this program.

3. All fees paid are NON-REFUNDABLE under any circumstances. This no refund policy includes donations raised, application fees, program fees, and program deposits.

4. If a student is away from the program or for a day from any program activities due to family travel, illness, or another purpose, program payments will not be refunded, nor pro-rated. No exceptions to this policy will be granted, however a program credit is available.
 
5. In the event a student is subject to involuntary or voluntary withdrawal while attending the program, is suspended, expelled, or otherwise required to leave the program for any reason, all fees paid to the program are strictly non-refundable and will be forefeited.

6. Any program scholarships cannot be combined with any other discounted offers. 
7. An NSF fee of $50 will be applied to all automatic debits processed with insufficient funds. This NSF MUST be paid within five (5) business days of the NSF notice. The ORGANIZERS reserves the right to suspend attendance to students with delinquent accounts or program fees not paid in full prior to the commencement of the program.

8. Program credits are not applicable and will NOT be granted if the registrant chooses to withdraw for any reason.

9. In the event that a student is ineligible or unable to attend the program for any reason including illness, any fees paid or raised through the fundraising pages will be issued as a credit only.
 
10. Any program fees will not be prorated during short program weeks.
 
11. In the event in-person classes need to move online or cancelled for any reason including a natural disaster, closure due to public health mandates, a pandemic, or mandated closure of our facilities, program fees not be refunded but only a portiion of the fees paid, or raised will be issued as a program credit. There are no exceptions to this policy.

By signing this declaration I acknowledge that:

– All fees paid are non-refundable.

– I am responsible for paying the posted registration fee of $20 to complete the application process in addition to a $250 deposit or the program fees paid in full.

– I understand that if I opt to pay the program fees in full before June 20, 2023, that the application fee will be waived.

– I understand that all fees paid are non-refundable.

– I understand that if my family goes on vacation or is away, that program payments are still due and will not be deferred.

– I am aware of the cancellation policies and agree not to dispute or attempt to chargeback the required charges.

– I am aware that if I fail to pay the program fees in full, that any previous monies paid will be forfeited.

– I acknowledge that my child must be enrolled in the level that corresponds with their age group.

– I acknowledge that my behaviour and my child’s behaviour are to remain respectful at all times. Any ill behaviour exhibited by myself as the parent/guardian and/or my child will jeopardize their placement in the program and may result in my child being removed from the program without further consideration for re-admission and that no refunds will be granted.

– I acknowledge that I am aware that this program carries risk. I have read and understood the contents of the indemnifying release.

– I understand that this program is taking place on a University Campus and that there will be many adults over the age of 18 present on Campus at random. I am declaring to assume all risk associated with this scenario.

– I understand that some of the facilitators are from post-secondary institutions, or from STEM-based corporations world-wide, and that they may not hold a vulnerable sector police clearance check in Canada, nor in their region. I am declaring to assume all risk associated with this.

– I confirm that I have reviewed and signed the Assumption of Risk Waiver and Release Form.

Signature – TERMS AND CONDITIONS, DECLARATION

PLEASE INITIAL ACKNOWLEDGEMENT OF REGISTRATION AGREEMENT

REGISTRATION AGREEMENT

By signing my name, I (or my legal guardian) affirm that I (or we) have meticulously read and understand the Cancellation Policy, Code of Conduct, Assumption of Risk and Indemnifying Release Statement, Medical Emergencies Statement, Dedication to Privacy Statement, Terms and Conditions and Disclaimer.

Date

Student’s Full Name:

Name of Parent or Guardian:

Address:

Phone:

Signature – REGISTRATION AGREEMENT

I would like additional information via email for upcoming virtual STEM Immersion Supplement Programs

Layout

Referral / Source

Thank you for your inquiry. Is there anything else you would like to mention?

Signature

About the Pre-University STEM Innovation Summer Program:

SECTION 1 – REGISTRATION FORM – Pre-University STEM Innovation Summer Program by the Canadian Institute of STEM Innovation

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

CUSTODY AND PRIMARY CAREGIVER INFORMATION (if different than the applying parent)

NAME(S) OF ADULT(S) TO WHOM CHILD MAY BE RELEASED (in addition to parents/guardians)

EMERGENCY CONTACT INFORMATION (in addition to parents/guardians)

DECLARATION OF INFORMATION:

SECTION 2 – CONSENT TO DISCLOSURE OF PERSONAL INFORMATION

ACKNOWLEDGEMENT FOR THE RELEASE AND STORAGE OF PARENT/GUARDIAN PERSONAL INFORMATION

SECTION 3 – HEALTH HISTORY AND PERSONAL INFORMATION

SECTION 4: STUDENT LEARNING NEEDS INFORMATION

SECTION 5: CONSENT TO PHOTOGRAPH AND USE STUDENT LIKENESS

SECTION 6: PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM SCHEDULE AND FEES

CONFIRMATION, PAYMENT, CANCELLATIONS AND REFUND POLICY

Flexible Residential Program Options (OVERNIGHT RESIDENCE) <br> – Students may register for 1,2,3,4 or 5 week stays and program choices

1 Week Residence Program – $1699

4 Week Residence Program – $6396

2 Week Residence Program – $3199

5 Week Residence Program – $7995

3 Week Residence Program – $4799

6 Week Residence Program – $9595

Residential Stream Daily Schedule

Day 1

Day 2 & 3

Day 4

Day 5

Flexible Day Program Options

Students will commute to and from home each day. The program runs daily from 8:45 am to 4 pm)

1 Week Day Program – $1299

4 Week Day Program – $4696

2 Week Day Program – $2398

5 Week Day Program – $5898

3 Week Day Program – $3597

6 Week Day Program – $7094

Day Stream Daily Schedule

Day 1

Day 2-3

Day 4 *Extended Day for Day Program Students to Accommodate the Awards Gala

Day 5

SECTION 7: PRE-UNIVERSITY STEM INNOVATION SUMMER PROGRAM COURSE & STREAM SELECTION – 2023

COURSE SELECTION: CHOOSE YOUR STEM INNOVATION STREAM

Week 1: July 3 – 7, 2023

Week 2: July 10 – 14, 2023

Week 3 July 17 – 21, 2023

Week 4 July 24 – 28 2023

Week 5 July 31 – Aug 4 2023

Week 6 Aug 7 – 11 2023

Week 7 Aug 14 – 18 2023

EXTRA OPTIONS:

SECTION 8: CONFIRMATION OF PAYMENT

After making your payment, please fill the following information regarding the payment made

SECTION 9: TERMS & CONDITIONS, WAIVERS

ACKNOWLEDGEMENTS, TERMS AND CONDITIONS