PLEASE FILL OUT THE FORM BELOW TO VIEW OUR BROCHURE ONLINE I am a:* Parent / Guardian Student Salutation* --None-- Mr. Ms. Mrs. Dr. Prof. Miss Rev. Parent Name:* Parent Email* Parent Phone* Street: City: Postal Code* State/Province: Country: Student Name:* Grade:* --None-- 5 6 7 8 9 10 11 12 Date Of Birth:* Student Email:* Student Phone:* Street: City: Postal Code:* State/Province: Country: Are youIs your child a previous Blyth Academy student?:* --None-- Yes No Parent Name:* Parent Email:* Please fill all the required fields! I am interested in learning about the following Programs:* International Summers & Comm. Service Blyth Academy Ontario Campuses Blyth Academy Online Blyth Academy Global High School Please fill all the required fields! Please select the program type(s) you are interested in:* International Summers (Academic Programs) Community Service (Volunteer Programs) Please fill all the required fields! Please select the Community Service program(s) you are interested in:* July Costa Rica March Break Costa Rica March Break Peru Please fill all the required fields! Please select the International Summers program(s) you are interested in:* Casa de Campo (9-12) Costa Rica (9-10) Scotland, England & Ireland (9-10) Amazon & the Galapagos (11-12) Grand Tour Asia (11-12) Australia, New Zealand & Fiji (11-12) China & the Trans-Mongolian Express (11-12) Costa Rica (11-12) Cozumel (11-12) Florence (11-12) France (11-12) Grand Tour Eastern Europe (11-12) Grand Tour Western Europe (11-12) Hawaii (11-12) Iceland (11-12) Italy (11-12) Japan (11-12) Ireland, England & Italy (11-12) Portugal (11-12) Rome & The Greek Islands (11-12) Spain (11-12) Double Credit Programs (11-12) Health & Wellness Programs (9-12) Please fill all the required fields! Please select which Global High School term(s) you are interested in:* Full Academic Year Semester 1 Semester 2 Term 1 only Term 2 only Term 3 only Term 4 only Please fill all the required fields! Please make a student selection:* Domestic (Canadian) Student International Student Please fill all the required fields! Please select which Blyth Academy program(s) you are interested in:* Full-time School Part-time School Night & Saturday School Private, Semi-Private & Repeat Courses Summer School Select the Campus(es) You are Interested In: Yorkville Lawrence Park Thornhill Downsview Park Whitby Burlington Waterloo Ottawa Mississauga Blyth@CIHA London Etobicoke Please fill all the required fields! Please select which full-time school term(s) / program(s) you would like to participate in.* Full Academic Year Sports Program Semester 1 Semester 2 Term 1 only Term 2 only Term 3 only Term 4 only Please select which part-time semester(s) you are interested in:* Part-time Fall Part-time Winter How did you hear about Blyth Academy?: Search Engine (eg Google) Social Media (Facebook, Twitter, Instagram.) Email Online Brochures and Printed Material Radio Friend or Colleague Student Rep Guidance Department Outdoor or Transit Ad Newspaper Ad Magazine Ad Other Student Rep Name:* Guidance Department School Name:* Search Engines - Web Search:* Google Yahoo Bing Ask AOL Baidu Other Social Media (Facebook, Twitter, Instagram):* Facebook Twitter Instagram Email campaign:* Email campaign from Blyth Academy Email campaign from other company Brochures and Printed Material:* Brochure Postcard Poster Mailing Other Please tell us your friend or colleague's name.* Web Search Online Ad Blyth Summers Web Page Blyth Academy Web Page Online article Brochure Postcard Poster Mailing Fax Other Online Ad Website Name:* 680News Virgin Radio Classical FM 980AM 1310AM Other --None-- Billboard Bus Advertising GO Train TTC Advertising Rink Board Other --None-- Globe and Mail Toronto Star Local Newspaper SNAP Other --None-- Post City Magazine Porter Magazine Toronto Life OSCA The Diplomat Other --None-- Parent Student Principal Partner Other --None-- Active Not Active Lead --None-- Academy Opportunity Travel Opportunity Receive Blyth Academy updates? Yes, I would like to receive occasional updates by email from Blyth Academy inclusive of exclusive offers & news. Please add me to the electronic communications list. By clicking “Submit”, I give permission for Blyth Academy to contact me. I understand I can unsubscribe at any time.