Attn: Parents or Guardians
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1 Attn: Parents or Guardians The Birchwood Hockey Academy will be starting early October and run through until March The program will run on Wednesday afternoons from 1:45pm to 3:45 pm and will take place at the MacLaughlin arena. Each student is responsible for covering a registration fee of $150 (cheques can be made payable to Birchwood Hockey Academy). This fee is to cover the costs of jersey s, socks, ice rentals, busing, Synergy fitness clesses and insurance fees. Parents/students are reminded that hockey bags are not permitted on the bus in the mornings. They can be either dropped off at the school or at MacLaughlin arena. Students will also be required to provide their own equipment, however jerseys and sock will be provided by the academy. We are really looking forward to the beginning of this year s season. If you have any questions or concerns, you may contact Mr. Brioux jxbrioux@edu.pe.ca or Mr. James tajames@edu.pe.ca. Sincerely John Brioux Todd James Birchwood Intermediate Page 1
2 BIRCHWOOD INTERMEDIATE SCHOOL 49 Longworth Avenue CHARLOTTETOWN, PEI C1A 5A6 Phone Fax Ron Carragher, Principal Patsy Macdonald Vice Principal HOCKEY CANADA SKILLS ACADEMY Student s Name: In order to qualify for the Hockey Canada Skills Program the student must complete an application package including the following. Students can either bring completed applications to school or mail completed application to: Birchwood Intermediate School Attention: Hockey Canada Skills Academy 49 Longworth Ave. Charlottetown PEI C1A 5A6 Please an X as each step is completed: 1. Application form 2. Read and agree to the three R s of the hockey program 3. Student application statement 4. Media consent form 5. Emergency contact information 6. Student Statement Due 3:00 PM Friday, June 16, 2017 Payment can be cash or cheque (cheques can be made payable to Birchwood Hockey Academy) Page 2
3 BIRCHWOOD INTERMEDIATE SCHOOL 49 LONGWORTH AVE CHARLOTTETOWN, PEI C1A 5A6 Phone Fax Ron Carragher, Principal Patsy MacDonald Vice Principal HOCKEY CANADA SKILLS ACADEMY APPLICATION FORM (* all information is required) Applicant Name: Date of Birth: Address: _ Province: _ Postal Code Parent s (Guardian s) Name: Work Phone: Home Phone: Cell: (mandatory) : In I will be in grade: T-shirt size: Position: please circle. Forward Defense Goalie Hockey Jersey Size: Please list your hockey experiences to date: Are there any special needs or conditions that we should be aware of? No Yes If yes, explain:. Page 3
4 EMERGENCY CONTACT INFORMATION Name: _ Home phone: Relationship: Work Phone: Cell: _ PARENT OR GUARDIAN CONSENT Name: Signature: please print Page 4
5 BIRCHWOOD HOCKEY CANADA SKILLS ACADEMY THE THREE R s OF THE HOCKEY PROGRAM RESPECT YOURSELF AND OTHERS I will give my full attention and effort in my regular classes and in the hockey program I will use positive and acceptable language I will take responsibility for my actions I will demonstrate respectful behavior to my teachers, coaches, classmates and Teammates RESPECT LEARNING I will arrive to classes on time and be prepared to learn I will complete assigned work to the best of my ability I will work hard to maintain good marks and will catch up on any class work missed due to the result of my involvement in the hockey program RESPECT OF PROPERTY I will treat my own personal property and that of others with respect I will do my part to display respect for the arena and its staff by keeping the dressing room clean. I will behave in a safe manner at all times whether in the school setting or at the arena Being accepted into the Birchwood Hockey Canada Skills program is an honor and a privilege. Along with this privilege comes a great deal of responsibility to maintain high standards for behavior. It is your behavior and performance both at the arena and within the school setting that will ultimately determine the success of this program. You must be prepared to behave in a manner that is acceptable to all of your classroom teachers, peers, as well as your on-ice instructors. This program is intended to help you improve your motivation, focus and performance in the classroom setting. Your best effort is expected in all aspects of the hockey skills program, your class work, off-ice fitness and the on-ice sessions as well. lf you agree to all of the above and agree to conduct yourself in a manner that is consistent with what is outlined above please sign below. Student Name: Student Signature: Date: Parent (Guardian) Signature: Page 5
6 Media Consent Form Dear Parent(s)/Guardian(s): We have been asked to send this Letter of Permission" form to you by The Eastern School District. We would like to point out that here at Birchwood Intermediate; there are times that student s pictures, without their name may appear. Student's names may be published in our school and classroom newsletters which are available on our website. If you have any questions, please do not hesitate to call us here at the school. Letter of Permission School web pages are public documents. As part of class/course projects, students may have the opportunity to publish their work via the Web. Anyone with access to the Internet may access your son/daughter's picture, name and/or work. With this in mind, please complete the form below and return it to your school. Name of Student: _ Parent/Guardian Signature: Date: I grant permission for my son/daughter's name to be published on the Internet and other forms of media. Parent/Guardian Signature Student s Signature: I grant permission for my son/daughter s photograph to be published on the Internet and other forms of media. Parent/Guardian Signature: Student's Signature: I grant permission for my son/daughter's student work to be published on the Internet. Parent/Guardian Signature: Student's Signature: Page 6
7 Student Application Statement In your own words write about the following three topics. Feel free to add more sheets if needed to properly answer these three questions. 1. Why do I want to be a part of the Birchwood Hockey Canada Skills Program? 2. How will my involvement in this program help me in the future? 3. I will be a good candidate for this program because... Page 7
8 HOCKEY CANADA SKILLS ACADEMY Information Sheet Birchwood Intermediate School Application Deadline: Friday, June 16, 2018 Program Duration: October March 2018 Ice Instructors John Brioux - On-ice head instructor is fully certified in the NCCP program Todd James - Assistant instructor fully certified in the NCCP program Guest coaches Program Outline 1 hour 10 mins of on-ice instruction, per week, based on Hockey Canada s skill development Program. Off ice hockey instruction that includes 2 Sessions at Synergy fitness as well as personal development, and leadership skills School Credit Program will be an extension of Physical Education and Health curriculum Transportation Students will bus to MacLauchlan arena Students will need to be picked up at the MacLauchlan at 3:45 p.m. and parents are responsible to drop off hockey gear, either prior to school or during lunch hour Equipment Students will be responsible to supply their own equipment Please note that all equipment must meet Hockey Canada Standards which includes a full face shield with the helmet Eligibility Students must fill out an application Application must be sent to Birchwood Intermediate School This program is open to any female or male student in grade seven to nine enrolled at Birchwood Intermediate School Page 8
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