Completion of Community Involvement Activities

Student’s Name ____________________________________ Grade___________

School: Dryden High School, 79 Casimir Ave., Dryden, ON P8N 2H4

Phone (807) 223-2316 Fax (807)223-2380

All activities must be completed at an approved site.

Lists of approved sites/organizations are available in the school or on school website at dhseagles.kpdsb.on.ca

Date Number

Of Hours

Activity Completed Organization Name

and telephone number

Supervisor’s name and signature

Total

_____________________________________________________________

Student’s Signature

_____________________________________________________________

Parent’s Signature

_____________________________________________________________

School Official Signature

FOR OFFICE USE

Prev. Hours _____________

Current Hours ___________

Total Hours ______________

Hours entered into Trillium

___________ ____________

Initials Date

Note to Students and Parents:

All activities must be done at an approved site.

Lists of approved sites/organizations are available in the DHS

main office, in the guidance office, and in the Community

Involvement section of the Guidance tab of the school website.

www.dhseagles.com

If a Volunteer Site is not on the approved site list, a contact

person at the volunteer site can complete a Volunteer Site

Sponsor Interim Request Form can be completed and submitted to

the Guidance office. Once approval is received it will be added to

the approved list.

3 Signatures are needed

o Student

o Parent

o Individual responsible for supervising the activity

Record all dates and hours accumulated at each site

Please ensure this form is kept in a safe location

Make a photocopy for your records before handing the

original into the Guidance Office

Hours can be handed in at any time during the year.

You do not have to wait until the form is full, you have

completed all 40 hours, or the end of the year.

Ministry of Education List of Ineligible Activities

An ineligible activity is an activity that:

Is a requirement of a class or course in which the student is enrolled (e.g. cooperative education portion of a course, job shadowing, work experience);

Takes place during the time allotted for the instructional program on a school day. However an activity that takes place during the student’s lunch breaks or “spare” periods is permissible;

Takes place in a logging or mining environment, if the student is under sixteen years of age;

Takes place in a factory, if the student is under fifteen years of age;

Takes place in a workplace other than a factory, if the student is under fourteen years of age and is not accompanied by an adult;

Would normally be performed for wages by a person in the workplace;

Involves the operation of a vehicle, power tools, or scaffolding;

Involves the administration of any type or form of medication or medical procedure to other persons;

Involves handling of substances classed as “designated substances” under the Occupational Health and Safety Act;

Requires the knowledge of a trades person whose trade is regulated by the provincial government;

Involves banking or handling of securities, or the handling of jewellry, works of art, antiques, or other valuables;

Consists of duties normally performed in the home (e.g. daily chores) or personal recreational activities, such as athletics, music, drama or

Involves a court-ordered program (e.g. community-service program for young offenders, probationary program).