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

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*
Location:
11km southwest of Tauranga
3km climb up Reid Road off Welcome Bay Road
Find us
Find us on:
Call us on:
07 542 5490