Campus Application

Student Information

Surname

First Name

Preferred Name

Gender MaleFemale

Date of Birth

Age

Citizenship

Country of Birth

Email Address

Contact Phone

Current Education

Name of Current School

School Email

Current Grade Attending

Current School Year Start Date

Current School Year End Date

Study Plan at BCA

Grade Applying For Youth CampSemesterGrade 9Grade 10Grade 11Grade 12Pre-University

Start Term September - DecemberJanuary - AprilMay - JuneOther

Specific Ontario Courses/Credits Needed

Goals Ontario Secondary School DiplomaESL

Area of Interest ArtsBusinessComputer StudiesEnglishScienceMathematicsSocial ScienceEngineeringOther

Area of Interest Other (specify)

Post-Secondary Goals University in CanadaCollege in CanadaUniversity in USAOther

Post-Secondary Goals Other (specify)

Student Services Information

Custodianship RequiredNot Required

Airport Pick-up RequiredNot Required

Accommodation and Care BCA AccommodationsPersonal Accommodations

Health insurance is provided to all students and included in school fees.

Parent and Family Information

Father

Father Surname

Father First Name

Father Date of Birth

Father Email

Father Cell Phone

Father Phone

Father Home Country Mailing Address

Mother

Mother Surname

Mother First Name

Mother Date of Birth

Mother Email

Mother Cell Phone

Mother Phone

Mother Home Country Mailing Address

Mother Province

Mother Country

Mother Postal Code

Home Phone

Emergency Contact MotherFather

Email address to receive information from BCA

Accompanying Family Member to Canada MotherFatherOther

Accompanying Family Other (specify)

Other Contact in Canada

Surname

First Name

Relationship to Student

Home Phone

Cell Phone

Work Phone

Email

Home Address

Province

Country

Postal Code

Medical Information

An up-to-date immunization record is required. A form outlining immunization requirements will be sent to accepted students.

Does the student have any allergies, medical condition, or take any medication? NoYes

If Yes, please describe

Does the student have a learning disability, physical handicap or behavioural concerns? NoYes

If Yes, please describe

Agency Information

Agency

Contact Person

I authorize the named agent to receive personal, school, and accommodation information electronically for the student named in this application.

Agreement

I have read, understand and agree to the payment policy, deferral fees, and refund of fees.

Supporting Documents

These documents are optional. If you attach them here, they will be sent with this application to info@bronston.ca. Accepted types: PDF, JPG, JPEG, PNG, DOC, DOCX. Maximum 5 MB per file.

Academic Transcripts

Photo ID

Immunization Record

Signatures

A typed name is accepted as if signed by hand.

Student Signature

Student Signature Date

Parent or Guardian Signature (1)

Parent or Guardian Signature (1) Date

Parent or Guardian Signature (2)

Parent or Guardian Signature (2) Date