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Girls U19 Hockey Roster 2022/23
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Student Health Documents
*
Indicates required field
Student Name
*
First
Last
Choose As Many As apply
*
Allergy (Animal/Insect/Drug/Environment/Food)
Asthma
Blood disorder
Bowel concern
DIabetes
Dietary
Educational Plan or ADD/ADHD
Fracture(s)
Hearing concern
Heart concern
Hepatitis
Hospitalization
Learning supports
Medication(s)
Mental health
Migraines
Physical limitations
Relationship concerns
Seizures, tics or tremors
Serious illnesses
Skin concern
Speech or language development
Stomach concern
Surgery
Urinary concern
Visual concern
Other
NONE
Comment required for each checked or type "none" if no concerns
*
Allergy Name - Reaction & Treatment or TYPE "NONE" IF NO allergy
*
WELL BEING INFORMATION so we are able to best support each child
*
Reports within Ontario File from previous school
Never been under any form of counseling care
Please book a call with school to discuss
well being information - is there any emotional triggers that teachers or coaches should be aware of?
*
Proof of Health Coverage
Every student is required to upload proof of health coverage for both Canada and the US before attending.
Ontario students are covered with OHIP Health Cards. All must provide proof of health insurance for emergency services in the USA.
Internationals can either produce coverage from a parent's employment plan, or purchase insurance through Guard.me Insurance plan. A21 Academy can assist in setting up Guard.me international health insurance as indicated in form below.
Please choose coverage and upload proof here:
Choose Health Coverage
*
Ontario OHIP Card (upload picture)
Other Coverage (upload picture)
I would like A21 to set up Guard.me Coverage
Upload Proof of Coverage CAN other than Guard.me
*
Max file size: 20MB
UPLOAD PROOF OF COVERAGE USA other than Guard.me
*
Max file size: 20MB
Upload STUDENT IMMUNIZATION RECORD or statement of relief
*
Max file size: 20MB
Click
HERE
to complete
and upload (to left)
STATEMENT OF RELIEF FORM
rather than Immunization.
Authorization to assist and transport your child in event of medical concern
I/we understand and acknowledge that the staff, officers, employees and agents of A21 Academy act in the place and position of guardian of my child(ren) while in attendance at A21 Academy. Recognizing this, I/we authorize each or any of them to provide to my child(ren) any medical treatment and support that they consider to be reasonable or necessary.
In consideration of their willingness to care for my child(ren), I/we release, remise and discharge, indemnify and save harmless, the A21 Academy Ltd, its Board of Directors, officers, employees and agents from any and all liability, claims or causes of action by virtue of application, or non-application of medical treatment and not liable for any accident or loss however caused. I/we agree to release A21 Academy from all claims and damages
Authorization is given to A21 Academy to assist and transport
*
I authorize A21 Academy
Submit
Academics
Parent Reviews
A21 Course Calendar & Principles
A21 Eagles
Home
Hockey
Girls U19 Hockey Roster 2022/23
Girls Prep
HOCKEY SCHEDULES
BOYS U18 HOCKEY ROSTER 2022/23
BOYS U16 Hockey Roster 2022/23
Camps & Tryouts
Hockey Coaches
Alumni
facility
Contact
A21 Application
Golf
Parent Portal