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The HWDSB Hockey Canada Skills Academy is a Specialized Learning Program offered by Hamilton- Wentworth District School Board (HWDSB) at Tapleytown Elementary School (390 Mud Street East Stoney Creek, ON L8J 3C6). We are accepting applications from students in grades 6 and 7 for entry into our Grade 7/8 class for the 2017-18 school year. Submit this application by March 31, 2017 to Tapleytown school. Specialized Learning Programs are innovative, unique and optional programs that focus on a specific area of study. These programs, developed with input from our community, are intended to engage students with varied educational interests and aptitudes. The Hockey Academy provides an opportunity for students to participate in the Grade 7-8 Hockey Canada Skills Curriculum, which will improve and develop overall fitness and hockey skills during the school day. Benefits: Sixty (60) on-ice learning opportunities each school year (approximately 30 per school term) Individualized training developed by Hockey Canada focused on student strengths and weaknesses Sports-specific strength and conditioning training focused on long-term athletic development Collaborative, differentiated instruction that creates a focused community of student-athletes What constitutes a good fit? Successful Hockey Academy students demonstrate the following qualities and characteristics: They are motivated, self-directed learners capable of working independently, completing work on time and following a contract model as required They are passionate about the game of hockey and would like to improve their skills They are willing to collaborate with others in academic, athletic and social pursuits They are committed to building a positive team atmosphere They believe in and support the program by attending regularly, being punctual and striving for academic success Find a digital copy of this application and more details about the program on the HWDSB website at: http://www.hwdsb.on.ca/elementary/programs/all/. For more information, please contact: Principal Doug Dunford, 905-662-2297, ddunford@hwdsb.on.ca Teacher Sean Kuczerepa, 905-662-2297, sekuczer@hwdsb.on.ca

Submit a completed application package to Tapleytown school. NOTE: A complete application package is due March 31, 2017 and will be date-stamped upon receipt. Each application MUST include the following: Registration Form includes Student Information, Written Responses, Expectations and Consent. Birth Certificate to show upon submitting the application package in order to verify birth date and legal name Out of Catchment Form (available on HWDSB website at http://goo.gl/sanzyn) Copy of student s most current report card (And Individual Education Plan (IEP) if applicable) Cheque for $100 deposit payable to Tapleytown Elementary School (Cheque may be post-dated to May 1, 2017 and is processed only when a student is accepted and enters the Hockey Academy.) Please Note: personal information on this form is collected under the authority of the Education Act and in accordance with the Municipal Freedom of Information and protection of Privacy Act [MFIPPA]. It will be used by the Principal and program staff to determine eligibility. Student Information Student s Surname Student s Given Names Age Birthdate (Day/Month/Year) Street Address Municipality Postal Code Parent/Guardian Name: Phone # Parent/Guardian Name: Phone # *Email: One email address only. All confirmation & program correspondence will take place via email with your consent. *Canada has implemented legislation which requires us to have your consent to send you emails with content related to commercial activity such as information on program fees, payment deadlines and anything associated with additional costs. By providing your email address here you consent to receive email correspondence from Tapleytown school. Student s current school: Individual Education Plan Yes No Student s current hockey organization: Current Grade: Identified Yes No Level: Positions: Total Years Played:

Written Responses HWDSB Hockey Canada Skills Academy Student Response: Why would you like to enrol in the HWDSB Hockey Canada Skills Academy? Parent Response: Why would you like to enrol your child in the HWDSB Hockey Canada Skills Academy?

Expectations and Consent HWDSB Hockey Canada Skills Academy Hamilton-Wentworth District School Board hopes that each student and their family will get the most out of the HWDSB Hockey Canada Skills Academy. By recognizing certain program expectations, we hope students and parents will be well informed and able to help create a successful school experience in this Specialized Learning Program. Please review the following sections and initial or circle your choice to indicate you have read and understood the expectations at the HWDSB Hockey Canada Skills Academy. Program Review I understand that the school will provide ongoing review of student needs related to program delivery, available resources and program fit. If my child s ongoing needs (academic or behavioural) prove greater than the supports available within the HWDSB Hockey Canada Skills Academy, a review and consultation will occur with the parent, classroom teacher and administrator to determine the student s suitability for continued placement in the program. The final decision will rest with the Principal. Initial Home / School Communication Specialized Learning Programs seek to establish an active, collaborative, supportive learning community of students, parents and teachers. Certain guidelines need to be followed to ensure a positive experience for the entire learning community. Parents are expected to relate to staff and other parents in a positive and professional manner using appropriate conflict resolution procedures to help create a supportive learning environment. Parent participation is valued but educators hold the ultimate responsibility for program delivery. I am willing to abide by the above guidelines. (Yes / No) Meetings A variety of meetings may happen during the school year. General meetings can occur as needed once per semester Our family is prepared to commit to attending meetings. (Yes / No) Transportation The Hockey Academy is an open catchment program it is open to any student in Hamilton-Wentworth District School Board. HWDSB does not provide transportation to any student attending a Specialized Learning Program. As such, families are responsible for providing transportation for their child(ren). Please be aware that this is a large commitment for families, one that can be costly and time consuming. I am aware that I will be responsible for providing transportation for my child(ren). Initial

Funding The HWDSB Hockey Canada Skills Academy is a Specialized Learning Program offered by HWDSB. As an optional program, it has costs that exceed the funding of a regular day-school program. A user fee of $700 is charged to each participant (based on enrolment) and covers: Transportation from the Mohawk 4 Pad. (HWDSB Bus Code of Conduct applies to all transportation provided for during this program.) Ice rental of the Mohawk 4 Pad. Hockey Canada Skills Academy Participant Registration One Hockey Canada Skills Academy Jersey One Hockey Academy Gym Uniform (Shorts and T-Shirt) Three to four visits to McMaster Fitness Program (pending availability) Payment Schedule: Registration Deposit March 31, 2017 $100 Second Instalment June 23, 2017 $300 Balance Due On or before Sept. 16, 2017 $300 As it develops, the HWDSB Hockey Canada Skills Academy may be enhanced with additional experiential learning activities. Parents will receive information about any additional costs on a per event basis. I am aware of the mandatory $700 user fee associated with this program and the potential of extra costs associated with Hockey Academy programming. Initial Admissions Considerations: Student applicants must be registered and enrolled in Grade 6 or 7. Students require a 70 per cent academic standing with no failures and continual demonstrated growth towards Ministry standards and acceptable learning skills with a focus on co-operation with others, independent work habits and the willingness to set goals for improvement. The program strives for a balance of male and female participants in the program. The school Principal will give applicants final approval of acceptance into the program. Priority will be given to students enrolled in Hamilton-Wentworth District School Board. A lottery will decide placement if the number of successful applicants exceeds space in the program. If more than one student applies from a family/household and the placement decision is based on lottery, all students from the household will be offered placement in the program upon one sibling being drawn. Successful applicants not drawn in the lottery will be offered a place on a wait list. Students accepted into the HWDSB Hockey Canada Skills Academy will complete a HWDSB Hockey Academy Contract in the September of each year they attend the program. I have read and understood the information on this application form. I understand that this application form does not guarantee admission to the program. Signed Signed Date Date