Vancouver Island Academy - Application of Admission
Registration form for Bridging Programs and English Communications Program
Parent/ Guardian Family Name *
Your answer
Parent/ Guardian First Name *
Your answer
*
Birth Date *
MM
/
DD
/
YYYY
Nanaimo Home Address *
Your answer
Telephone *
Your answer
E-mail *
Your answer
Emergency Contact
Name of contact *
Your answer
Relationship *
Telephone *
Your answer
E-mail *
Your answer
Elementary Bridging Program (Ages 8-12)
Start Date
Student #1 Family Name
Your answer
First Name
Your answer
Birth Date
MM
/
DD
/
YYYY
Student #2 Family Name
Your answer
First Name
Your answer
Birth Date
MM
/
DD
/
YYYY
High School Bridging Program (Ages 13-18)
Start Date
Student #1 Family Name
Your answer
First Name
Your answer
Birth Date
MM
/
DD
/
YYYY
Student #2 Family Name
Your answer
First Name
Your answer
Birth Date
MM
/
DD
/
YYYY
English Communications (Adults)
Parents learn English in adult classes and share activities and field trips with their children.
Start Date
Parent #1 Family Name
Your answer
First Name
Your answer
Parent #2 Family Name
Your answer
First Name
Your answer
Submit
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