Youth Academy Registration

Student Section

Are you a machine? If not please enter nothing in here:
Name*
Address*
Date of birth*
Gender*
Landline
Cellphone*
Email*
School*
Current Year*
Why do you wish to attend the Academy*

Parents Section

Parent/Guardian Name*
Parent/Guardian Cellphone*
Parent/Guardian Email*
Please list any medical or special dietary needs
  If my teenager requires significant medical assistance every effort will be made to contact me. If I cannot be reached, I give full permission for Summerhill Academy staff to act in my teenager's best interests, and agree to meet any expenses incurred.*
  I give Summerhill Academy permission to publish images/videos of my teenager for promotional purposes (if you have any questions/concerns contact Danny Kettoola).*