PRINCE GEORGE COUGARS
PRINCE GEORGE COUGARS
2016-17 BILLET APPLICATION FORM Thank you for your interest in becoming a Billet for the Prince George Cougars Hockey Club. All information obtained will be kept confidential. Upon receipt of your completed form, you will be contacted for an interview. Please return completed form to: The Prince George Cougars, #102-2187 Ospika Blvd. S., PG, BC, V2N 6Z1 1. LAST NAME:__________________________________________________________________ FIRST NAME:__________________________________________ HM PH:__________________________ WK PH:__________________________ CELL PH:___________________________ E-MAIL ADDRESS(ES):___________________________________________________________________________________ WORK
HOME
OCCUPATION:____________________________________________________________________ HOW LONG:_______________ 2. LAST NAME:__________________________________________________________________ FIRST NAME:__________________________________________ HM PH:__________________________ WK PH:__________________________ CELL PH:___________________________ E-MAIL ADDRESS(ES):__________________________________________________________________________________ WORK
HOME
OCCUPATION:____________________________________________________________________ HOW LONG:________________ ADDRESS:______________________________________________________________________________________________ STREET NAME
POSTAL CODE
AREA OF CITY:__________________________________________________________________________________________ OWN: p YES p NO
RENT: p YES p NO
HOW LONG:_____________________________
PLEASE LIST ALL OTHER MEMBERS OF YOUR HOUSEHOLD: NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
HAVE YOU BILLETED FOR THE COUGARS PREVIOUSLY? p YES p NO IF YES, WHICH SEASON(S):_______________________ ARE YOU WILLING TO BILLET MORE THAN ONE PLAYER? p YES p NO
p DEPENDS (PLEASE SPECIFY)_______________________________________________________________________
ARE YOU WILLING TO PROVIDE TEMPORARY HOUSING (UP TO 2 WEEKS) FOR PLAYERS IN TRANSITION? p YES p NO
p DEPENDS (PLEASE SPECIFY)_______________________________________________________________________
DO ANY MEMBERS OF THE HOUSEHOLD SMOKE? p YES p NO
LIST ALL PETS:___________________________________
PLEASE DESCRIBE THE LIVING SITUATION YOU HAVE FOR PLAYERS: p
PRIVATE BEDROOM
p
SHARED BEDROOM (PLEASE SPECIFY WITH WHOM)______________________________________
p
PRIVATE BATHROOM
p
SHARED BATHROOM (PLEASE SPECIFY WITH WHOM)______________________________________
OTHER:________________________________________________________________________________________________
_________________________________ SIGNATURE
_________________________________ SIGNATURE
_______________________ DATE
2016-17 BILLET APPLICATION FORM Thank you for your interest in becoming a Billet for the Prince George Cougars Hockey Club. All information obtained will be kept confidential. Upon receipt of your completed form, you will be contacted for an interview. Please return completed form to: The Prince George Cougars, #102-2187 Ospika Blvd. S., PG, BC, V2N 6Z1 1. LAST NAME:__________________________________________________________________ FIRST NAME:__________________________________________ HM PH:__________________________ WK PH:__________________________ CELL PH:___________________________ E-MAIL ADDRESS(ES):___________________________________________________________________________________ WORK
HOME
OCCUPATION:____________________________________________________________________ HOW LONG:_______________ 2. LAST NAME:__________________________________________________________________ FIRST NAME:__________________________________________ HM PH:__________________________ WK PH:__________________________ CELL PH:___________________________ E-MAIL ADDRESS(ES):__________________________________________________________________________________ WORK
HOME
OCCUPATION:____________________________________________________________________ HOW LONG:________________ ADDRESS:______________________________________________________________________________________________ STREET NAME
POSTAL CODE
AREA OF CITY:__________________________________________________________________________________________ OWN: p YES p NO
RENT: p YES p NO
HOW LONG:_____________________________
PLEASE LIST ALL OTHER MEMBERS OF YOUR HOUSEHOLD: NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
NAME:_____________________________________________________________________
AGE:____ p MALE p FEMALE
HAVE YOU BILLETED FOR THE COUGARS PREVIOUSLY? p YES p NO IF YES, WHICH SEASON(S):_______________________ ARE YOU WILLING TO BILLET MORE THAN ONE PLAYER? p YES p NO
p DEPENDS (PLEASE SPECIFY)_______________________________________________________________________
ARE YOU WILLING TO PROVIDE TEMPORARY HOUSING (UP TO 2 WEEKS) FOR PLAYERS IN TRANSITION? p YES p NO
p DEPENDS (PLEASE SPECIFY)_______________________________________________________________________
DO ANY MEMBERS OF THE HOUSEHOLD SMOKE? p YES p NO
LIST ALL PETS:___________________________________
PLEASE DESCRIBE THE LIVING SITUATION YOU HAVE FOR PLAYERS: p
PRIVATE BEDROOM
p
SHARED BEDROOM (PLEASE SPECIFY WITH WHOM)______________________________________
p
PRIVATE BATHROOM
p
SHARED BATHROOM (PLEASE SPECIFY WITH WHOM)______________________________________
OTHER:________________________________________________________________________________________________
_________________________________ SIGNATURE
_________________________________ SIGNATURE
_______________________ DATE
