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PEP Arizona Academy Player Application 2021/2022

PLEASE COMPLETE THIS APPLICATON ACCURATELY AND COMPLETELY BEFORE SUBMITTING TO AVOID PROCESSING DELAYS.

Student Information

Last Name

First Name

Entry Grade

Date of Birth

Sex

Male Female

HAVE YOU BEEN A STUDENT AT A PRIVATE ACADEMY IN THE LAST 365 DAYS (IF YES, PLEASE INDICATE WHERE)?

DO YOU HAVE AN INDIVIDUAL EDUCATION PLAN (IEP)?

Parent Guardian 1

Last Name

First Name

Email

Street Name

City

State

ZIP Code

Home Phone

Business Phone

Cell Phone

Parent Guardian 2

Last Name

First Name

Email

Street Name

City

State

ZIP Code

Home Phone

Business Phone

Cell Phone

PRIMARY CONTACT:

Both Parent/Guardian 1 Parent/Guardian 2

Student Resides with:

Both Parent/Guardian 1 Parent/Guardian 2

IF PARENTS ARE SEPARATED, WHICH PARENT IS THE LEGAL GUARDIAN OF THE APPLICANT?

Joint Parent/Guardian 1 Parent/Guardian 2

Player History

Position

Shoots

Current Team

Division

Level

Last Years Team

Last Years Division

Last Years Level

TELL US ABOUT YOUR PLAYER OFF THE ICE:

TELL US ABOUT YOUR PLAYER ON THE ICE:

CURRENT COACH COMMENTS:

Coach Name

Coach Email

Coach Phone

Please confirm your acceptance of the terms below:

YOUR REGISTRATION FEE OF $1500.00 MUST ACCOMPANY THIS COMPLETED APPLICATION IN ORDER TO RESERVE YOUR SPOT AT PEP ACADEMY AND IS DUE JUNE 30, 2021

PLEASE NOTE PEP WILL RETAIN YOUR CREDIT CARD INFORMATION ON FILE ONLY AS LONG AS THE STUDENT REMAINS WITH PEP ACADEMY EITHER TO COVER THE INSTALMENT PAYMENTS IF YOU SELECTED THIS OPTION OR FOR ANCILLARY FEES AND COSTS THAT MAY BE INCURRED DURING THE YEAR.

ALL CANCELLATIONS MUST BE MADE IN WRITING

REGISTRATION FEES ARE NON-REFUNDABLE UNDER ANY CIRCUMSTANCE

AN NSF FEE OF $50 WILL BE APPLIED TO ALL CHECKS PROCESSED WITH INSUFFICIENT FUNDS.

LATE PAYMENTS WILL BE ASSESSED A $50 SURCHARGE FOR FAILURE TO PAY BY THE DATE(S) SPECIFIED ON ALL INVOICES.

PEP ACADEMY WILL REFUND 100% OF THE TUITION FEES PAID IN THE EVENT THAT WE ARE NOT ABLE TO OFFER A PROGRAM.

I HAVE READ AND AGREE TO THE TERMS AND FEES OF THIS PROGRAM. I AM AWARE OF THE CANCELLATION POLICIES AND AGREE NOT TO DISPUTE OR ATTEMPT TO CHARGE BACK THE ABOVE SIGNED FOR AND ACKNOWLEDGED CHARGE(S). I AM AWARE IT IS MY RESPONSIBILITY TO ENSURE SUFFICIENT FUNDS ARE AVAILABLE IN ALL ACCOUNTS ATTACHED TO CHECKS ISSUED FOR PAYMENT.

I UNDERSTAND THAT THE TUITION PAID DOES NOT INCLUDE THE COST OF BOOKS (HARDCOVER OR E-BOOKS), SCHOOL SUPPLIES, FIELD TRIPS, SPECIAL EVENTS, ETC.

TUITION INLCUDES PEP JERSEY, TRACKSUIT, HAT.

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