Summer High School Prep Program
#200-688 West Hastings Street, Vancouver, British Columbia, V6B 1P1 Canada
T: 1.604.687.8832 / E: e.elliot@alexanderacademy.ca
www.alexanderacademy.ca
2015 Application Package
First Name
Female Male
Family Name
Nationality Native Language
Date of Birth (dd/mm/yy) Gender
Street Address
City Province/State
Postal Code Country
Home phone Mobile phone
PARENT ONE Contact Name
PARENT ONE Emergency Contact Phone Number
Do you require medical insurance?
Student’s Approximate Level of English: (Check appropriate box)
Elementary Lower-Intermediate Upper-Intermediate Advanced 1 2 3 4 5 6 7 8
Housing Start: (dd/mm/yy) Housing Finish: (dd/mm/yy)
Insurance Start: (dd/mm/yy) Insurance Finish: (dd/mm/yy)
Program Start date: (dd/mm/yy)
Program Options (Please check all that apply )
Program Finish Date: (dd/mm/yy) Registration Date: (dd/mm/yy)
Arrival date (dd/mm/yy) Arrival time (hh:mm) Airline & Flight No.
Departure date (dd/mm/yy) Departure time (hh:mm) Airline & Flight No.
Do you require airport transfer? On Arrival: Yes No For Departure: Yes No
Yes No
Yes, I have read, understand and accept all of the enrolment conditions and refund po licies.
Sign full name and date to indicate you have agreed to the terms and
conditions.
Agent’s Information (Optional)
Signature Parent One Date
Summer High School Prep Program
student information
Parent(s) Signature(s)
Program Information
Week One - July 6 - 10 - Ecosystems Week Two - July 13 - 17 - History Week Three - July 20 - 24 - Technology Week Four - July 27 - 31 - Forensics
Week Five - August 4 - 7 - Theatre Week Six - August 10 - 14 - Great Canadians
Week Seven - August 17 - 21 - Ecology
Accommodation Information
(All students MUST have medical coverage for their full study period - please include copy with your application)
Homestay
Single room – Full Board Double room – Full Board
Fee Information
note
Weekly Fee $750.00 Week Five SPECIAL $600.00
All 7 weeks - receive a 25% discount on tuition
Homestay
$210.00 / week - includes 3 three meals
Total Program Cost Accommodation fees Airport transfer(s)
Medical insurance = Total Cost Due All payments must be made in Canadian dollars.
All payment documents must include: [1] Full name of student, [2] Programstart date
Payment Information
Custodianship
Yes No
Medical problems or allergies:
Not needed
Medical Insurance Provider Name
Emergency Contact for Insurance Policy #
Early Bird Registration - Before May 31, 2015
$90.00 each way
Airport Transfer
Regular Registration - After May 31, 2015
Weekly Fee $850.00 Week Five SPECIAL $680.00
All 7 weeks - receive a 20% discount on tuition
Signature Parent Two
Student Information
Date PARENT TWO Contact Name
PARENT TWO Emergency Contact Phone Number
Custodianship
$50.00
Alexander Academy & IH Vancouver
Summer High School Prep Program
Off-Campus Field Trip Permission
Statement of understanding and permission for
full participation in Alexander Academy and International House’s off-site programs.
Full Name of Student:______________________________ Dates of Program: _________________
STATEMENT OF PERMISSION:
I have read and understood the details noted on page 2 of this form.
I hereby give permission for (print student name here) _________________________________
to participate in all aspects of Alexander Academy and International House’s Summer High School Prep Program, scheduled during the normal day, from 9:00am – 4:00pm. The Alexander Academy and International House Summer High School Prep Program includes but is not restricted to the following field trips:
• Lynn Canyon Ecology Centre & Suspension Bridge ● Police Museum
• Musqueum Cultural Centre UBC ● Fly over Canada / Canada Place • Museum of Anthropology UBC ● Arts Club Theatre
• Van Arts / Vancouver Film School ● BC Sports Hall of Fame • Museum of Vancouver ● Stanley Park & Ecology Centre
I understand that Alexander Academy teachers/leaders/volunteers will accompany the students on all off-campus activities and that they will consider the student’s safety to be of primary importance at all times. I understand that transportation arrangements for off campus activities will involve my child travelling by any of the following modes: public transportation including bus, Skytrain, Canada Line, Seabus, or chartered school bus.
I agree to hold Alexander Academy and International House, its employees and volunteers harmless from any damage or injury to my child that may occur, however caused.
If emergency medical treatment is required, I give permission for the teacher in charge or other leaders to authorize
the appropriate medical authority to proceed with treatment in my absence.
□
I DO NOT give permission for my child to participate in the following activity /activities:
________________________________________________________________________________
Signature of Parent / Guardian Date
2
Revised March 2015
OFF-CAMPUS ACTIVITIES
Field studies are an integral part of the Summer High School Prep Program. It is important that we
have parental permission for students to participate fully in the High School Prep Program, both on
campus and away from the school site.
This permission form covers normal off-campus school trips during the regular program from
Monday to Friday from 9:00am to 4:00pm from July 6, 2015 to August 21, 2015.
All field trips will take place during the regular program day, during regular program hours and will be
located in the Metro Vancouver Area.
Supervision of the students will be direct and indirect depending on the nature of the activity. Most
field trips will also be supervised and/or led by a workshop facilitator at the field trip destination in
addition to the Alexander Academy or IH teacher.
Risks:
•
There are inherent risks associated with all field trips and forms of transportation including:
o
injuries or even death resulting from motor vehicle accidents occurring during travel
to, at, or from the field trip site;
o
Injury or even death resulting from acts of nature, such as earthquake, or fire;
o
Injury from improper use of props or displays at field trip site;
o
Damage or vandalism to, or theft or loss of personal property;
Transportation:
•
Transportation to field trip sites will be arranged using one or more of several means of
transportation:
o
Walking
o
Public Transport (including the Sea Bus, Skytrain, Canada Line, bus)
REFUND AND CANCELLATION POLICIES
1. Non-refundable fees
The medical insurance fee is non-refundable.
2. Program Changes
Students who wish to postpone their start date may do so with a minimum two weeks prior written notice. Please note the end date of the program is August 21st and all paid weeks of the program must be completed prior to the end of August 21st, 2015. In the event of postponement and the student being unable to complete all previously purchased weeks of the program due to the restriction of the length of program, the % refunded for weeks not attended will be in accordance to the Cancellation Policy. Weeks of study may not be downgraded once they have commenced except in the event of postponement. Weeks of study may be increased based on availability and with two weeks’ notice.
3. Rejection by Immigration Canada
Students unable to obtain a visa are entitled to a full refund less all non-refundable fees.
Students must request a refund in writing four weeks prior to the start of their course and submit a copy of the rejection letter issued by Immigration Canada as soon as possible, otherwise the cancellation policy will apply to the refund.
4. Cancellation
Date of cancellation % refunded
30+ days prior to start date 75% 7 to 29 days prior to start date 50% 0 to 6 days prior to start date 35% After 0% to 20% of program 25% After 20% or more of program 0%
NB: Program refers to the total number of weeks for which the student is registered. If a student is registered for 4 weeks, the program length is 4 weeks.
BANK INFORMATION
Bank Name: Bank of Montreal
Account Name: Alexander Academy Corporation
Account Number: 39330 001 1997667
Swift Code: BOFMCAM2
Bank Address: Burnaby Main Office
