Youth Academy Registration

Student Section

Are you a machine? If not please enter nothing in here:
Name*
Address*
Age*
Gender*
Phone*
Cell*
Email*
School*
Yr*
Please provide your reasons why we should choose you for this Academy*
Please attach your C.V.*

Parents Section

Parent/Guardian Name
Parent/Guardian Phone
Parent/Guardian Cell
Please list any medical or special dietary needs

I understand that if my teenager requires significant medical assistance that every effort will be made to contact me. In the event that I cannot be contacted, I give my permission for the Summerhill A1 Youth Academy staff to act in my teenager's best interests, and I agree to meet any expenses incurred.

  I am the parent or guardian and I agree to the above*