Centennial Secondary/School District 43 Hockey Academy – Year 5!
New Applicants Bantam & Midget
‘The pursuit of academics & hockey excellence’

The academy is open to male and female students of every skill level, in grades 9 through 12 who are registered at Centennial as of
the 2013/14 school year. This includes students who were approved for a cross boundary permit into Centennial before the cross
boundary deadline in March 2013. Charles Best students can join the Hockey Academy & remain at Charles Best.

The cost will be $1120 or 5 payments of $224.00 (includes HST) for a one semester (five month) program. The program will be
offered first semester (September to January).

The program includes 3 on ice sessions and 2 off ice sessions per week as well as performance testing, classroom sessions and
special events. 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
Centennial on the ice at all times. * Goaltending instruction will be provided if there is sufficient demand (2 to 4 goaltenders per
group). Certified on-ice staff and assigned teacher will instruct all off-ice and attend events.

Our program will likely run from 10:45-11:45am at the Coquitlam Recreation Centre.

Students will be given four credits for a Board of Education approved hockey course upon successful completion of the program.

Interested parents and students are strongly encouraged to attend our:
Parent Information Night Grade 8
Thursday, February 8th
Parent Information Night Grade 9, 10, 11 Wednesday, February 13th
6:00pm
6:00pm
Centennial Secondary Room #102
Centennial Secondary Room #102

We will begin accepting new applicants/completed registration forms and payment at 8:00am on Monday, February 18th at the
Centennial 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.

Early registration does not guarantee a spot in the program. Successful candidates will be based on the following criteria:
*Student is registered to attend Centennial for September 2013
*Student has demonstrated a respectful and responsible approach to being a student and hockey player.
*Date and time of registration
For more information contact:
Rob Zambrano
Keith Peterson
Craig Millin
Centennial Secondary School
Academic Teacher
Pacific Rim Hockey Academy
rzambrano@sd43.bc.ca
KPeterson@sd43.bc.ca
craig@rpmhockey.com
604-936-7205
604-936-7205
604-476-0464
Building great kids...in the classroom, on and off the ice and in their community!
SCHOOL DISTRICT #43
CENTENNIAL HOCKEY ACADEMY
PACIFIC RIM HOCKEY ACADEMY
570 Poirier St. Coquitlam, B.C. Canada. V3J 6A8
School 604-936-7205 Fax: 604-937-5933 email: centennial@sd43.bc.ca
www.rpmhockey.com
Fax 604-477-7277
Registration Inquiries: holly@rpmhockey.com
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: _____________________Expect to be enrolling in Grade: ___ at ❐Centennial/at (school name) ❐____________________
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? _____________________________________________________________________.
Payment for the academy can be made in total $1120 or by deposit of $224 and 4 monthly payments of $224. (September to December):
cheque or credit card (postdated use the payment schedule dates below)
I will pay for this academy by:
Check ❐
Visa ❐
Master Card ❐
American Express ❐
Card Number _________/__________/__________/____________/ Exp _________/__________
Method of payment:
❐
Cheque/Credit Card payment in full - $1120.00
❐
Cheque/I have included a deposit $ 224.00 along with 4-$224.00 post dated checks (September to December)
❐
Credit Card /please process $224.00 (deposit) along with 4-$224.00 (monthly payments September to December)
Cheques made payable to PRHA or Pacific Rim Hockey Academy. *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:
Payment 1
Deposit at time of Registration
$224
(withdraw before June 30th – Deposit/Full refund)
Payment 2
September 1
$224
(withdraw after June 30 but before September 1 – lose your deposit)
September 15 Withdrawing - you must contact our office and the school (lose your Deposit, September payment & Academy clothing)
Payment 3
October 1
$224
Payment 4
November 1
$224
Payment 5
December 1
$224
Registrations received after Sept 10 – 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 craig@rpmhockey.com or info@rpmhockey.com
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: _________________