MBSS HOCKEY CANADA SKILLS ACADEMY
MBSS HCSA PROGRAM
2019/20 ONLINE APPLICATION
SCHEDULE
CONTACT
2017-18 MBSS hCSA PROGRAM
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Indicates required field
Student Name
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First
Last
Birthdate (mm/dd/yyyy)
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Gender
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Male
Female
1 .Parent/Guardian Name
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First
Last
Cell Number
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Parent/Guardian Email
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2. Parent/Guardian Name
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First
Last
Cell Phone Number
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Parent/Guardian Email
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Home Address
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Line 1
Line 2
City
State
Zip Code
Country
Enter Canadian Province & Postal Code
Phone Number
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Home Email
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Current School
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MBSS
CNBMS
GMS
Other
Current School Other (if not listed above)
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Current Grade
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Grade 11
Grade 10
Grade 9
Grade 8
Current Division
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Midget
Bantam
Not playing minor hockey
Current Team
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Tier 1
Tier 2
Tier 3
Tier 4
House
Not playing minor hockey
Position Played
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Defence
Forward
Goalie
MBSS HCSA Program Fees/Non Refundable Deposit Info(please read)
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yes
MBSS HCSA program fee is $850.00. You will receive an email from the SD23 school board office with payment instructions for the deposit and program fees. The $200.00 non-refundable deposit is due May 1st. Please check yes that you are aware that the SD 23 HCSA program has a $200.00 non-refundable deposit.
Student/Athlete Contract
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yes
As a student/athlete in the SD23 Hockey Academy I will: 1. perform to the best of my abilities in all my classes, which include Hockey Academy 2. attend all of my classes unless I have a serious reason for absence 3. be on time for all of my classes 4. abide by all school rules and it's Code of Conduct 5. not bully nor attempt to injure any of my Hockey Academy classmates 6. wear Hockey Canada Sanctioned equipment and dress in full gear. Failure to follow the above criteria may result in suspension/removal from SD23 HCSA. Please make sure you read this with your son or daughter who is applying for the program. By checking yes you are agreeing to all points in the student/athlete contract
Parent Contract
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yes
I am aware of the commitment level needed for success in the program, I am supportive of my child's participation and I endorse this application. I have read the Student/Athlete contract. Please check Yes to approve the submission of this application
Parent/Student Authoriztion
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yes
The SD23 HCSA is a high profile program. Pictures of your sun/daughter in program related activities may be used for the purpose of promotion and communication for the program. I/we authorize all information contained within this application/contract.
Please Note: To ensure that fees and deposits do not prohibit student participation, the Board will facilitate fair and confidential procedures to allow participation by students who would otherwise be excluded. Please contact the program coordinator (click Contact tab above) to discuss and explore options.
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