Dawson Creek Secondary/School District 59 Hockey Academy – Year 3
New Applicants: Grade 8/9 Bantam & Grade 10, 11, 12 Midget
The academy will have two groups and will be open to male and females, of every skill level. Grade 8/9 Bantams and Grade 10, 11, 12
Midgets who are registered at Dawson Creek Secondary students as of the 2013/14 school year.

Grade 8/9 Bantam Group - Linear Program (September 2013 to January 2014) Cost $500 or 5 payments of $100.00 Program includes 3
sessions each week (Sept 2013–January 2014) – Power Skating, Puck Skills, Tactical and off ice conditioning, workshops, special
presentations and Personal Growth & Leadership. Our ice time will likely rotate throughout the school timetable. The Hockey Academy
will end at the end of January and the students will continue with their regular PE.

Grade 10, 11, 12 Midget Group – Semester 1 Program (September 2013 to January 2014) Cost $700 or 5 payments of $140.00 Includes
3 on-ice sessions each week Power Skating, Puck Skills and Tactical. And 2 off-ice training sessions week as well as performance testing,
theory, special events and our Personal Growth and Leadership component that includes Respect in Sport, Practice Planning, Bio
Mechanic skill instruction, teaching opportunities and mentoring inside the Minor Hockey Association. Our ice time will likely rotate
throughout the school timetable.
The Hockey Academy does not interfere with Minor Hockey (students participate in their respective minor hockey associations) &/or school
sports.
There will be two professional on ice hockey instructors/coaches and one goaltending instructor as well as a trained teacher from Dawson
Creek Secondary on the ice at all times. * Goaltending instruction will be provided if there is sufficient demand (2 to 4 goaltenders per group).
Students will be given four PE or BAA credits upon successful completion of the program.

Interested new parents and students are strongly encouraged to attend our Information Meeting on Wednesday, January 30th at
7:00pm at Central Campus-Cafeteria.

We will begin accepting new applicants/completed registration forms and payment at 8:30am on Thursday, January 31 at the
Central Campus School office or online at www.rpmhockey.com Registrations will be accepted on a first come, first served basis
and will be date and time-stamped, registrations will not be accepted before this time.
Successful candidates will be based on the following criteria:
*Student is registered to attend Dawson Creek Secondary in September 2013
*Student has demonstrated a respectful and responsible approach to being a good student and hockey player
*Date and time of registration - Space is limited.
For more information contact:
Josh Kurjata
Craig Millin
Holly Rogers
Vice-principal
Pacific Rim Hockey Academy
Academy Registrations
[email protected]
[email protected]
[email protected]
250-782-5585
1-604-476-0464
1-604-476-0464
Building great kids...in the classroom, on and off the ice and in their community!
SCHOOL DISTRICT #59
DAWSON CREEK SECONDARY HOCKEY ACADEMY
PACIFIC RIM HOCKEY ACADEMY
10808-15th St, Dawson Creek B.C. Canada. V1G 3Z3
School 250-782-5585 Fax: 250-782-7221 email: [email protected]
www.rpmhockey.com
Fax 604-477-7277
Registration Inquiries: [email protected]
APPLICATION FOR ACCEPTANCE - 2013-2014 School Year
Parent/Guardian’s Name: ______________________________ Parent E-Mail: _______________________________
Student’s Name: _________________________________ Student’s Date of Birth: M___/D____/Y___
Address: _____________________________________________Postal Code: ________________Home Phone #: _______________________
Current School: _________________Enrolling in Grade: ___
Please note the school administration may request a copy of your student’s latest report card prior to the decision making process
# of years playing: ___ I play at what level? _______ Position: _______________ Minor Hockey Association: ________________________
Please note that the above information will be verified by officials in your minor hockey association as part of the application.
What are your academic goals? ________________________________________________________________________________________.
What are your athletic goals? __________________________________________________________________________________________.
Why would you be a good candidate for this academy? _____________________________________________________________________.
I am planning to attend the ❐ Grade 8/9 Program or the ❐ Grade 10/11/12 Program
Payment for the academy:
Grade 8/9 Total = $500 or by deposit (required with application) of $100 and 4 monthly payments of $100. (Sept 1 to Dec 1).
*Grade 10/11/12 Total = $700 or by deposit (required with application) of $140 and 4 monthly payments of $140. (Sept 1 to Dec 1).
*Cost Difference the Grade 10/11/12 program is a 5 day a week program (Semester) the Grade 8/9 is a 3 day a week program (Linear)
I will pay for this academy by:
Cheque ❐
Visa ❐
Master Card ❐
American Express ❐
Card Number _________/__________/__________/____________/ Exp _________/__________
Method of payment depending on the Program you are planning to attend:
❐
Cheque/Credit Card payment in full - $500 or $700
❐
Cheque/I have included a deposit $100 or $140 along with 4-$100 or $140 postdated checks (Sept 1 to Dec 1)
❐
Credit Card /please process $100 or $140 along with 4-$100 or $140 postdated checks (Sept 1 to Dec 1)
Cheques made payable to RPM Hockey Company. *Please include Students 1st and Last Name on all Cheques
NSF cheques are subject to a $25 Administrative Fee. Payments, Academics & Behavior not in good standing, could result in
restricted participation.
Academy Payment Schedule depending on the Program you are planning to attend:
Payment 1
Deposit at time of Registration
$100 or $140 (withdraw before June 30th – Deposit/Full refund)
Payments 2-4
Sept 1-Dec 1
$100 or $140 (withdraw after June 30th but before Sept 1 – lose your deposit)
Sept 15
Withdrawing – you must contact our office and school (lose your Deposit, Sept payment & Academy clothing).
Registrations received after Sept 30 – are not guaranteed Academy clothing
Administration is provided by the Pacific Rim Hockey Academy. Should your student withdraw from the academy for any reason you must
email Pacific Rim Hockey Academy at [email protected] or [email protected]
Parent/Guardian’s Name _____________________________
Parent/Guardian’s Signature ____________________________
Please note your completed application and payment does not guarantee your child’s acceptance to the Hockey Academy. Administration
reserves the right to place students. All decisions are final and not open to appeal.
Section E (Completed by Administration)
Accepted ❐
Not Approved ❐
Wait List ❐
Comments ____________________________________________________ Date and Time Received: _________________