Our Lady of Mount Carmel
Grade 3 Academy Program Contract 2016 - 2017
Name: ___________________________
Address: _________________________
Previous School: ___________________
Gender: M___ F___
Phone: _____________ Alternate Ph: ____________
Email: ________________________
Please indicate the Academy your child will be attending and then fill out the corresponding section of this contract.
___Hockey ___Soccer
___Elite Athlete Program
1. Acceptance into an Academy will not be confirmed until the non-refundable deposit is remitted with the child’s
registration.
2. It is the parent’s/guardian’s responsibility to ensure timely payments based on the applicable Academy monthly
installment schedule below. If any of the payments are defaulted or are late, the child may be removed from
the Academy program.
*A child will not receive any Academy apparel, sports clothing or kits and may be precluded from the Academy
program until the first installment is made.
3. I agree to pay the 2016-2017 Academy fees as indicated below (please check one):
Soccer Academy: Total $1060
____Lump sum payment of $1060
____Non Refundable Deposit of $250.00 plus 9 Monthly payments of $90.00 (Sept.–May)
Hockey Academy: Total $1240
____Lump sum payment of $1240
____Non Refundable Deposit of $250.00 plus 9 Monthly payments of $110.00 (Sept.–May)
Elite Program: Total $200 (Sport: _______________________________)
____Lump sum payment of $200 (Additional costs may be incurred for transportation)
A portion of the student fees are determined by expenses in advance booking of facilities, transportation, staffing and activities.
Early withdrawal from an academy will result in administrative charges to cover the student’s portion of these advance costs as
mentioned above. Such charges will be prorated and determined on an individual basis. In addition, any student withdrawing
early from an academy will forfeit all right to academy apparel.
4. I would I would like to utilize the following method of payment for the lump sum payment or Academy Deposit
(please check one):
_____ Credit Card ____ VISA ___ MC
Card Number __________________________________________ Expiry Date _____
_____ Cheque
Office Use Only – Application Approval
Academy: _____________
Previous School: ______________
_____ Cash
5. I would like to utilize the following method of monthly payment (please check one):
_____ Credit Card ____ VISA ____ MC
_____
Card Number __________________________________________ Expiry Date _____
Postdated Cheques (please include all cheques with contract and deposit)
If any circumstances occur which may change my ability to meet the payment required, I agree to immediately contact the
Office Administrator to make alternate arrangements.
Registration for Academy programs also requires a completed Student Information Form and
accompanying documents before a student will be considered.
By signing this document I acknowledge that I have read and agreed to all of the terms and conditions indicated
above.
____________________
__________________________________
Date
Name of Parent/Guardian (please print)
__________________________________
Signature of Parent/Guardian