Please complete this application in full and forward it to the school. Acceptance into the Athletic Academy Program is at the discretion of the school administration and program staff. Limitations may be established based on the total number of participants and available classroom space.

Program Choice English Track French Immersion Track

o

Ronald Harvey Hockey Academy § Grades 4, 5, and 6 § Cost: $230.00/month

o

Lois E Hole Hockey Academy

§ Grades 4, 5, and 6 § Cost: $230.00/month

o

WD Cuts Hockey Academy § Grades 7, 8, and 9 § Cost: $230.00/month

o

Sir George Simpson Hockey Academy § Grades 7, 8, and 9 § Cost: $230.00/month

Student Information

Last Name First Name

Address City Postal Code

Birthdate Grade

(at the beginning of the current school year) Current Level Of Hockey/Tier

Legal Guardian(s)’ Information Last Name First Name

( ) ( ) ( ) Home Phone Business Phone Cell Phone

Relationship: o Father o Mother o Guardian o Other (Specify) _____________________

Email

Last Name First Name

( ) ( ) ( ) Home Phone Business Phone Cell Phone

Relationship: o Father o Mother o Guardian o Other (Specify) _____________________

Email

§ A non-refundable deposit must accompany this application form. Deposits will be processed upon acceptance into the program. Cheques must be dated no later than June 1st, 2017 and must be payable to St. Albert Public Schools.

§ Please sign and date the payment schedule on the back of this page and return the application form and your deposit to your school of choice.

Hockey ProgramSt. Albert Public Schools Athletic Academy

Student Application Form

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Hockey Academy Payment Schedule Acceptance into The Academy will not be confirmed until the non-refundable deposit of $230.00 is remitted with your child’s registration.

During “Registration Week” in September, regular school fees must also be paid in full.

Payment # Due at Amount 1 Registration $230.00 (non-refundable) 2 September 1 $230.00 3 October 1 $230.00 4 November 1 $230.00 5 December 1 $230.00 6 January 1 $230.00 7 February 1 $230.00 8 March 1 $230.00 9 April 1 $230.00

10 May 1 $230.00 A portion of The Academy fees are determined by expenses incurred for advance booking of facilities, staffing, transportation, and activities. Early withdrawal from The Academy may result in administrative charges to cover the student’s portion of these expenses. Such charges will be pro-rated and determined on an individual basis.

Agreement I agree that it is my responsibility to ensure timely payments. If I default in meeting any of the above payments, I understand that my child may be excluded from the program. I understand that my child will not receive any sports clothing or kits until the first installment is made. I also understand that if the first installment is not paid by September 15th, my child may be excluded from the Academy Program until the payment has been made.

I would like to utilize the following form of payment

o Lump sum payment of $2,300.00 o Monthly payments of $230.00 o Postdated cheques (please include all cheques with application and deposit)

I, the undersigned, give consent for ____________________________ (child’s name) to participate in the St. Albert Public Schools Athletic Academy. I authorize school administration and program directors to access his/her student records.

Signature of Parent/Legal Guardian _____________________________

Name of Parent/Legal Guardian (Please print): ___________________________________

Date: _____________________________

Note: The information collected on this application form contains personal information covered by the Freedom of Information and Protection Privacy Act. This information is collected pursuant to the provisions of the School Act and will be used for authorized programs and activities that are a part of normal school life. If you have any questions about the collection, please contact the District’s FOIP Coordinator, Michael Brenneis, Associate Superintendent of Finance, at 60 Sir Winston Churchill Avenue, St. Albert, AB T8N 0G4, phone (780) 460-3712

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