Request for Financial Assistance (Barracudas - Burlington Girls Hockey Club)

Print Request for Financial Assistance
Please ensure that you have completed the entire form before you submit it. You need only complete the Area(s) of the form that apply to the type of assistance that you are requesting. You submit the form by clicking on the SUBMIT button. By submitting this form you certify that the information provided to the BGHC is accurate. You know that the form has been submitted if you get a new page in your browser that shows the following: Your Response Has Been Submitted Thank you for completing the form, it has been saved in our database and sent to the appropriate people.
Player Information
Parent/Guardian Information
  1. Example: ###-###-####
Type of Assistance Requested
The BGHC offers 2 forms of assistance, depending on the program: direct reduction of fees up to $200 and extended payment terms. Direct reduction of fees is available only to House League program participants. Extended payment terms are available to all program participants.
Extension of Payment Requests
Complete this section if you are requesting an extended time to pay, beyond the published payment deadline.
Cash Assistance Request
Complete this section if you are requesting a cash assistance/reduction of fees.
  1. Check All That Apply
Other Information
Human Validation