Mount Academy Application Form

Student Information
Child Legal Name*

First NameMiddle NameLast Name
Date of Birth (DD, MM, YY)*

DayMonthYear
Date of Birth (DD,MM,YY)*
Age
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child identify as indigenous
In keeping up with the PSB & CSLF, we submit this information to the province of Prince Edward Island.
Number of Siblings
First Language*
Second Language*
If English is not your first language, please answer the following:
English Writing Ability *
English Speaking Ability *
Will your child be living in residence*

YesNo

Academic Information
Entering Grade in 2024/25*
Name of Current School*
Current School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child have an:*

IEPadaptationsaccommodationsacademic resourceNone of the above
IEPs, Adaptations, Psycho-Evaluation or any other documentation

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School Transcripts*

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Student Personal Essay (250 word essay) *

Please submit a 250 word essay explaining why you wish to attend Mount Academy.
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Athletic Information

To ensure a seamless reference process for your application, please provide the contact details of a teacher and a coach below. By entering their contact information, you agree to us sending them a form with questions relating to your child's behaviour and abilities. The information gathered in the reference forms will not be shared outside the admissions committee and they will be used to help determine your child's eligibility to attend the Mount Academy
Program Enrollment (every student must participate an athletic programs)*

Female HockeyMale HockeySkills HockeyIce Skills
Is the student consulting with an agency or family advisor? If yes, please indicate who with their contact information

Hockey
Current Team
Current Level
AA, AAA...
Position
Previous Coach Reference

First NameLast Name
Team Name
Email
example@example.com
Top Three Preferred Jersey Numbers
We cannot guarantee you will receive your preferred jersey number.
Upload Player Video

if unable to submit a video, please send one directly to our sport director Paddy Flynn at pflynn@themountacademy.ca
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Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you.
Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Relationship to Child*
Emergency Contact #2
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Relationship to Child

Payment and Statement Understanding
Application payment of $100 is required prior to application review.

Applications will be reviewed by the admissions committee. Mount Academy will contact you once the applications have been processed and approved. Please allow for the processing time.

Application Fee*

Application Fee

$100.00CAD

Total

$0.00CAD

	Poor	Below Average	Average	Above Average	Excellent
Work Ethic
Honesty/Integrity
Maturity (relative to age)
Self-Motivation
Consideration for others
Relationships with peers
Relationships with adults
Leadership abilities
Reactions to suggestions/advice
Taking responsibility for own actions
Overall Behaviour

Mount Academy New Applicant Registration Form