Academy Application Form - Delta School District

New or Returning Applicant*

New Applicant
Returning Applicant

Were you attending in March 2020 when the program closed due to COVID?*

Yes
No

School Year*

Which school year are you registering for?

Registering for 2021-2022 School Year

SELECT ONE ACADEMY:*

STUDENT INFORMATION

Student Name*

First Middle Last

Student Birth Date*

Mailing Address*

Street Address City Province Postal Code

Home Phone

Gender (optional)

Female
Male

Current School (select the Out of District option if not in Delta)*

Specify Out of District school name and city*

Grade (as of September 1, enrolling year)*

Which Delta School will you attend for your non-academy blocks?*

PARENT/GUARDIAN INFORMATION

I 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?*

Yes
No

Parent/Guardian Address*

Street Address City Province Postal Code

Parent/Guardian Email Address*

Enter Email Confirm Email

Parent/Guardian Contact Phone

Parent/Guardian Name (2)

First Last

Is Parent/Guardian (2) address same as student address?

Yes
No

Parent/Guardian (2) Address

Street Address City Province Postal Code

Parent/Guardian (2) Email Address

Enter Email Confirm Email

Parent/Guardian (2) Contact Phone

ACADEMY SPECIFIC INFORMATION

If 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*

Right
Left
Both

Dance 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 Phone

Agency Name

** LIST RECENT FILM WORK (ROLE/SHOW) IF APPLICABLE **

1. Show/Role

Directed by

2. Show/Role

Directed by

** LIST RECENT VISUAL EFFECT WORK IF APPLICABLE **

1. Production/Role

Visual Effects Software

Please list all Visual Effects Software that you have experience using:

Directed by

2. Production/Role

Directed by

1. Please list all film courses you have taken

2. Please list all Film Festival Awards you have won

3. Provide an on-line link to any film work you would like to share with us

Current Golf Course Membership?*

Yes
No

Name of Club*

Golf Experience (number of years)*

Experience Level*

Beginner
Intermediate
Advanced

Current Handicap/Index*

Golf Instructor's Name

First Last

Golf Instructor's Phone

(###) ###-####

Program Fees, Withdrawing, Payment Options

Program 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 Academy

If this student has a sibling who attends another Academy, please specify the Academy below:

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 phansen@deltasd.bc.ca

Please note: Registration is not complete until payments have been made.