Academy Application Form Academy Application Form New or Returning Applicant*New ApplicantReturning ApplicantWere you attending in March 2020 when the program closed due to COVID?*YesNoSchool Year*Which school year are you registering for?Registering for 2021-2022 School YearSELECT ONE ACADEMY:*Please select your AcademyDance - Delta SecondaryFilm Acting - DMECFilm Production - DMECVisual Effects - DMECGolf - Seaquam Secondary (North End)Lacrosse - DMECSTUDENT INFORMATIONStudent Name* First Middle Last Student Birth Date*Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Mailing Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home PhoneGender (optional)FemaleMaleCurrent School (select the Out of District option if not in Delta)*Select one of the school options belowOut of DistrictAnnieville ElementaryBeach Grove ElementaryBurnsview SecondaryBrooke ElementaryChalmers ElementaryCliff Drive ElementaryCougar Canyon ElementaryDelta SecondaryDelview SecondaryDevon Gardens ElementaryEnglish Bluff ElementaryGibson ElementaryGray ElementaryHawthorne ElementaryHeath ElementaryHellings ElementaryHolly ElementaryJarvis ElementaryLadner ElementaryMcCloskey ElementaryNeilson Grove ElementaryNorth Delta SecondaryPebble Hill ElementaryPinewood ElementaryPort Guichon ElementaryRichardson ElementarySands SecondarySeaquam SecondarySouth Delta SecondarySouth Park ElementarySunshine Hills ElementarySpecify Out of District school name and city*Grade (as of September 1, enrolling year)*Select a grade level0809101112Which Delta School will you attend for your non-academy blocks?*Select one of the school options belowBurnsview SecondaryDelta SecondaryDelview SecondaryNorth Delta SecondarySands SecondarySeaquam SecondarySouth Delta SecondaryPARENT/GUARDIAN INFORMATIONI grant my son/daughter permission to participate in the above specified program. I certify that all statements on this application are true and complete.Parent/Guardian Name:* First Last Is Parent/Guardian address same as student address?*YesNoParent/Guardian Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent/Guardian Email Address* Enter Email Confirm Email Parent/Guardian Contact PhoneParent/Guardian Name (2) First Last Is Parent/Guardian (2) address same as student address?YesNoParent/Guardian (2) Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Parent/Guardian (2) Email Address Enter Email Confirm Email Parent/Guardian (2) Contact PhoneACADEMY SPECIFIC INFORMATIONIf the student is unable to answer any of the following mandatory (*) questions below then simply enter N/A or Not Applicable.Field Lacrosse Age Group*Field Lacrosse Level*Box Lacrosse Age*Box Lacrosse Level*What hand do you shoot with*RightLeftBothDance School*How many years of dance?*Instructor's Name (1)* First Last Instructor Phone (1)Instructor's Name (2) First Last Insructor's Phone (2)** LIST AGENCY INFORMATION IF APPLICABLE **Agent's Name First Last Agent's PhoneAgency Name** LIST RECENT FILM WORK (ROLE/SHOW) IF APPLICABLE **1. Show/RoleDirected by2. Show/RoleDirected by** LIST RECENT VISUAL EFFECT WORK IF APPLICABLE **1. Production/RoleVisual Effects SoftwarePlease list all Visual Effects Software that you have experience using:Directed by2. Production/RoleDirected by1. Please list all film courses you have taken2. Please list all Film Festival Awards you have won3. Provide an on-line link to any film work you would like to share with usCurrent Golf Course Membership?*YesNoName of Club*Golf Experience (number of years)*Experience Level*BeginnerIntermediateAdvancedCurrent Handicap/Index*Golf Instructor's Name First Last Golf Instructor's Phone(###) ###-####Program Fees, Withdrawing, Payment OptionsProgram Fees Application fee and uniform fee due Immediately and are non refundable 20% of total tuition due by program start date ("Deposit") 40% of program fee is due Day 1 40% of program due on Week 5 The program can be paid for all at once should you prefer A payment schedule will be sent to you Family Discount The sibling who attends the Academy with the lowest fee will receive a 25% discount. Sibling AcademyIf this student has a sibling who attends another Academy, please specify the Academy below:Specify the sibling's Acacemy if applicableDance - Delta SecondaryFilm Acting - DMECFilm Production - DMECVisual Effects - DMECGolf - Seaquam Secondary (North End)Lacrosse - DMEC Withdrawing from the Program If you withdraw from the program, refunds will only be issued as follows: No refund on uniforms and/or gear regardless of withdrawal date Withdrawal prior to program start date will result in losing the 20% deposit Withdrawal after the start will result in loss of all monies paid Note: No refund on application fee, uniforms and/or gear regardless of withdrawal date. Payment Options Cheque - Make payable to Delta School District Cheques should be brought to Delta Manor Education Centre at 4750 57 Street in Ladner Credit Cards Accepted - Visa/MasterCard/Amex You will be required to phone the Academy office at (604) 952-5374 and give your credit card information Bursaries: Financial Assistance may be available with demonstrated need. Apply early to Paige Hansen at email@example.com Please note: Registration is not complete until payments have been made.