Delta Academy & Delta GEMS INTEREST FORM
Let's Get Your Details!
Student Full Name
First Name
Last Name
Date of Birth
Student Date of Birth
-
Month
-
Day
Year
Date
Student Grade Level
Please Select
6
7
8
9
10
11
12
Student E-mail
example@example.com
Student Phone Number
Parent/Legal Guardian
First Name
Last Name
Parent/Legal Guardian Phone Number
Parent/Guardian Email
example@example.com
Emergency Contact if different
Number of people attending:
Please Select
1
2
3
4
5
6
7
8
9
10 or more
What are the names of the other people coming, if any?
Anything you want to add?
We look forward to seeing you at our Kickoff & Parent Orientation on Sunday, October 5 at 2:00 PM - Campbell AME 25 Boundary St. Bluffton. All parents/guardians must attend the first 30 minutes.💌 Questions? Contact Gwen Chambers at gwendst21@gmail.com/ 843.540.6292(text).
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