2016/2017 Energy School Challenge
School Participation Form
This School Participation Form (the “Form”) enables your school’s participation (as an “Applicant School”) in the 2016/17 “Energy School
Challenge” program (the “Challenge”) that is being offered by Enbridge Gas Distribution Inc. (“Enbridge”). Please confirm with your
Enbridge Energy Solutions Consultant that your school board is participating in the Challenge prior to submitting this Form.
Please provide all the information requested in Part A: Application Form, review the information attached, and then indicate your school’s
interest in participating by dating and signing Part B: Declaration. Return the completed Form to ENBRIDGE GAS DISTRIBUTION
INC., P.O. Box 725, Toronto ON, M1K 0A3 Fax: 416-753-6607 Attention: Lisa J. Scott or email a scan of the signed and dated Application
to: [email protected]. BY SIGNING PART B, APPLICANT SCHOOL ACKNOWLEDGES ITS RECEIPT AND
ACCEPTANCE OF THE TERMS AND CONDITIONS ATTACHED. IN ADDITION, APPLICANT SCHOOL ACKNOWLEDGES THAT
ENBRIDGE MAY CANCEL THE CHALLENGE AT ANY TIME AND MAY REJECT OR ACCEPT ANY FORM AT ANY TIME ACTING IN
ITS SOLE AND ABSOLUTE DISCRETION.
PART A: APPLICATION
Section 1: School Information
Name of School (the “Applicant School”):
Address:
City:
Primary Contact:
Phone No.:
Postal Code:
Email:
Section 2: Applicant School Building Information (the “Building”)
Building Address: (If different from above)
City:
Square Footage of Building:
Number of Students (2015/2016):
Currently pursuing Ontario Eco Schools accreditation:
Yes
No
Postal Code:
Number of Students (2016/2017):
Faculty Contact Name:
Green Team in Place:
Contact Phone No.:
Contact Email:
Yes No
Section 4: Enbridge Information (to be completed by Enbridge)
Name of Enbridge Energy Solutions Consultant: (the "ESC")
Building has a MetreTek meter:
Yes No
Building meter can be upgraded to a MetreTek meter on or before November 15, 2016:
SRM Opportunity #:
Sector:
PART B: ACKNOWLEDGEMENT
THE UNDERSIGNED CERTIFIES THAT THE INFORMATION GIVEN ABOVE IS CORRECT, AND ACKNOWLEDGES AND ACCEPTS THE
TERMS AND CONDITIONS ATTACHED HERETO. THE FACULTY CONTACT IDENTIFIED ABOVE SHALL WORK WITH ENBRIDGE AND
ENSURE THAT ALL CHALLENGE REQUIREMENTS ARE MET IN A TIMELY FASHION.
________________________________________________
Signed on behalf of Applicant School
________________________________________________
Name (Please Print)
________________________________________________
Date (MM/DD/YYYY)
________________________________________________
Title
2016-09-00205 School Energy Challenge Form