Request for Financial Assistance (Burlington Girls Hockey Club)
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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
*
Select One...
House League
Initiation Program
Rep 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?
*
Select One...
Direct reduction of fees
Extended payment terms
Both
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?
JumpStart
KidSport
Other
Check All That Apply
How much assistance have you been approved to receive from these other sources?
Other Information
Please provide any other information that you wish to communicate with respect to this request.
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
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Thu Mar 04, 2021
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