Request for Financial Assistance (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

Player Name (first and last)^*
BGHC Program^*

Parent/Guardian Information

Parent/Guardian completing this form^*
Phone number for best contact^*

Example: ###-###-####
Email address^*

Example: [email protected]

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.

What type of assistance are you requesting?^*
Please provide a brief reason for your request.^*

Extension of Payment Requests

Complete this section if you are requesting an extended time to pay, beyond the published payment deadline.

Please provided the timing and frequency of payments you wish us to consider.

Cash Assistance Request

Complete this section if you are requesting a cash assistance/reduction of fees.

What amount of direct reduction to fees are you requesting (maximum is $200).
Which of the following forms of assistance have you applied for to date?
JumpStartKidSportOther
Check All That Apply
How much assistance have you been approved to receive from these other sources?