COOPER ACADEMY ADMISSIONS 2019-20

2019 - 2020

ADMISSIONS

WWW.COOPERACADEMY.ORG
COOPER INTERNATIONAL ACADEMY

OFFICE OF ADMISSIONS
2664 APPLEWOOD DRIVE
ONTARIO, CALIFORNIA 91761

(951) 538-8549
[email protected]

APPLICATION

2019-2020 Academy Program Application

Step 1: Application - All Documents Must be Submitted in English - Application consideration
for all grade levels will be initiated when Steps 1 and 2 are completed:

Application

1. Copy of Passport or U.S. Birth Certificate or Resident Alien Card

2. Character Reference Form: The applicant will need (2) completed Character
Reference Forms completed by an adult (not a family member), who has
known the applicant for a minimum of one year and who can speak about the
applicant’s character and integrity.

-Education Forms for Under Graduate and Post Graduate Program

1. Official School Transcript, including most recent grade report. Applicants to high
school (grades 9-12) or the Post Graduate Program must submit all secondary
school records, including 8th grade academic reports.

-Application Processing:

1. Application Processing Fee: $150 non-refundable fee ($250 International): U.S.
check or money order should be made payable to Cooper International
Academy

2. If you wish to pay by PayPal or credit card visit

http://www.cooperacademy.org/payments-and-donations.html

3. Return Application by email or US mail:

Email: [email protected] or 2664 Applewood Dr., Ontario, CA 91761

4. International wire transfer information on back page

2019-2020 Cooper International Academy Application Form

APPLICATION INFORMATION

FOR OFFICE USE ONLY Date: Time: Initials:

Student Enrollment/Emergency Information

Name Middle Last

SS Number Date of Birth Sex Home Phone Cell Phone
Email Last Grade Completed
Last Grade Completed

Mailing Address

City State Zipcode

Race: White: Black: Hispanic: Asian: European: African: Other:__________

Country of Origin: Alternative Emergency Contacts
What language do you speak at home: Secondary Emergency Contact

Primary Emergency Contact

Home Phone Cell Phone Home Phone Cell Phone
Email



Email

City, State, Zip Code City, State, Zip Code

Hospital/Clinic Preference Medical Information Phone Number
Physicians Name

Insurance Company Policy Number

Allergies/Special Health Considerations

Please enclose a Application Form
copy of front and
back of your
medical card.

2019-2020 Cooper International Academy

CHARACTER REFERENCE FORM1

PART 1

To the Applicant:

Please submit this form to an adult (non-relative) who has known you for at least one year in a
non-academic area of your life (i.e. sport coach, extracurricular activities, job, church, family
friend, etc.). This should be a person who can speak about your character, integrity and work
ethic.

To the Recommender:

The above named applicant is applying for enrollment to Cooper International Academy. Our
program is a competitive and demanding sports training program. Our student body comprises
individuals from across the USA. The program should be undertaken only by students/athletes of
unquestioned motivation. Individual character, integrity and initiative are important to success in
our community since demands on the individual are high.

We thank you in advance for the help your judgments will provide. Your knowledge of the
applicant and willing- ness to give us an honest appraisal will prove invaluable in our decision-
making process. We assure you that all aspects of your recommendation will be kept
confidential.

Please return this form in a sealed envelope to the applicant or send directly to the Director of
Operations (2664 Applewood Dr., Ontario, CA 91761). Thank you for taking the time to
complete this character reference form.

2019-2020 Cooper International Academy Initials:
Application Form

CHARACTER REFERENCE FORM1
PART 2

1. How long have you known this applicant?
2. What is your relationship with him?
3. What are the first three words from the list below that describes the applicant?

1.____________, 2._____________, 3._____________

a) Integrity/Character b) Considerate c) Responsible d) Cooperative
e) Motivational f) Dedicated g) Coachable h) Leader
i) Confident j) Persistent k)

CHARACTER REFERENCE

5. Please describe the applicant’s overall attitude, cooperation and involvement with peers and
elders.

6. Are you aware of any family circumstances that affect the student’s life at school, sport, etc.?
Please explain:

7. Which word(s) best describe the parents in regard to their child?

8. Please share with us any additional qualities, strengths, weaknesses or experiences you think
we should be aware of as we evaluate the applicant’s candidacy for Cooper International
Academy.

Today’s Date: Position:
Name:
Email Address: Phone:

2019-2020 Cooper International Academy Application Form

CHARACTER REFERENCE FORM2
PART 1

To the Applicant:

Please submit this form to an adult (non-relative) who has known you for at least one year in a
non-academic area of your life (i.e. sport coach, extracurricular activities, job, church, family
friend, etc.). This should be a person who can speak about your character, integrity and work
ethic.

To the Recommender:

The above named applicant is applying for enrollment to Cooper International Academy. Our
program is a competitive and demanding sports training program. Our student body comprises
individuals from across the USA. The program should be undertaken only by students/athletes of
unquestioned motivation. Individual character, integrity and initiative are important to success in
our community since demands on the individual are high.

We thank you in advance for the help your judgments will provide. Your knowledge of the
applicant and willing- ness to give us an honest appraisal will prove invaluable in our decision-
making process. We assure you that all aspects of your recommendation will be kept
confidential.

Please return this form in a sealed envelope to the applicant or send directly to the Director of
Operations (2664 Applewood Dr., Ontario, CA 91761). Thank you for taking the time to
complete this character reference form.

2019-2020 Cooper International Academy Initials:
Application Form

CHARACTER REFERENCE FORM2

PART 2

1. How long have you known this applicant?
2. What is your relationship with him?
3. What are the first three words from the list below that describes the applicant?

1.____________, 2._____________, 3._____________

a) Integrity/Character b) Considerate c) Responsible d) Cooperative
e) Motivational f) Dedicated g) Coachable h) Leader
i) Confident j) Persistent k)

CHARACTER REFERENCE

5. Please describe the applicant’s overall attitude, cooperation and involvement with peers and
elders.

6. Are you aware of any family circumstances that affect the student’s life at school, sport, etc.?
Please explain:

7. Which word(s) best describe the parents in regard to their child?

8. Please share with us any additional qualities, strengths, weaknesses or experiences you think
we should be aware of as we evaluate the applicant’s candidacy for Cooper International
Academy.

Today’s Date: Position:
Name:
Email Address: Phone:

2019-2020 Cooper International Academy Application Form

RELEASE AND WAIVER

PART 1

Please read carefully, then date, print & sign below!

I understand that this Release and Waiver of Liability governs all rights and liabilities, relating in
any way to the receipt by me from Cooper International Academy and/or its agents of Services,
as defined below. I have read, understand, and agree to be bound by the terms below.

Definitions:

“Services” shall mean any and all manner of goods and services offered by Cooper International
Academy or any other Released Party to you. These services, which may take the form of
training, treatment, consulting, and the like, expressly include, but are not limited to: evaluations,
rehabilitation, reconditioning, performance planning, performance training (including strength &
conditioning training, speed & quickness training, plyometric train- ing, recovery and
regeneration training), sports nutrition consultation, supplement and nutrition provision, any
consultation related to any item in this list, injury reduction and treatment, technical and tactical
instruction and performance enhancement.

“Training” shall mean any act or activities required or carried out by you in relation to the
Services. “Released Parties” shall mean all Cooper International Academy, staff and employees
and all related governmental entities, in relation to the previously – listed respective Released
Parties, all of their officers, directors, share- holders, insurers, sponsors, partners, employees,
employers, agents, successors, contractors, assigns, affiliates, parent corporations, affiliated
corporations, and subsidiary corporations.

Terms and Provisions

The risk of injury from participation in sporting events and other strenuous physical activity,
including Training, is significant, including the potential for permanent paralysis, other serious
injury, and/or death. I KNOWING- LY AND FREELY ASSUME ALL SUCH RISKS of
participation in Training, including, without limitation, risk arising from or relating in any way to
the condition of the facilities, equipment, fields, and surrounding premises, the actions of persons
other than myself, my own actions, and travel to and from the Training. I UNDERSTAND THAT
THE RELEASED PARTIES MAKE NO WARRANTIES and shall in no event be responsible or
liable for the defective or dangerous condition of the facilities, equipment, fields, and
surrounding premises, except to the extent such condition(s) result(s) solely from the gross
negligence or intentional acts of a Released Party.

Please read carefully, then date, print & sign below! Initials:
2019-2020 Cooper International Academy Application Form

RELEASE AND WAIVER

PART 2

I AGREE THAT THE RELEASED PARTIES SHALL NOT BE LIABLE for any claims, demands,
injuries, damages, actions, or causes of action that arise in whole or in part due to the simple negligence
of the Released Parties. FURTHERMORE, I FOREVER RELEASE AND DISCHARGE, AND AGREE
TO INDEMNIFY AND HOLD HARMLESS, the Released Parties from and in relation to all claims,
demands, injuries, damages, actions, or causes of action that arise from or relate in any way to my
participation in the Training, other than such claims, demands, etc. that arise solely from the gross
negligence or intentional acts of a Released Party. I FURTHER WARRANT AND CERTIFY that I have
no health conditions or defects that would prevent me from participating safely in the Training and
Competition, that I have taken every reasonable act necessary to make this warranty and certification in
relation to such participation, and that I am otherwise sufficiently fit and healthy to so participate.

I WARRANT AND UNDERSTAND that it is my sole and personal responsibility to obtain insurance to
compensate for any and all injuries which might arise from my participation in the Training, and
furthermore agree to look solely to such insurance to cover losses resulting from any injuries, regardless
of fault, and waive all rights of subrogation on behalf of any and all Released Parties which may now or
ever exist as a result of such insurance.

IN ANY EVENT, THE LIABILITY OF A RELEASED PARTY TO ME FOR ANY REASON AND
UPON ANY CAUSE OF ACTION SHALL NOT EXCEED THE AMOUNT ACTUALLY PAID BY ME
TO COOPER INTER- NATIONAL ACADEMY DURING THE SEVEN MONTHS IMMEDIATELY
PRECEDING MY ASSERTION OF SUCH CLAIM. THIS LIMITATION APPLIES TO ALL CAUSES
OF ACTION IN THE AGGREGATE, INCLUDING, WITHOUT LIMITATION TO EQUITY, BREACH
OF CONTRACT, BREACH OF WARRANTY, NEGLIGENCE, STRICT LIABILITY,
MISREPRESENTATIONS, AND OTHER TORTS.

If any paragraph, subparagraph, sentence or clause of this Agreement shall be adjudged illegal, invalid or
unenforceable, the balance of the Agreement shall remain in full force and effect. This Agreement shall be
construed and interpreted under California law. Any lawsuit or claim arising from or relating in any way
to Training or Competition, Services, and/or this Agreement shall be brought, if at all, in the County of
Los Angeles and San Bernardino, California.

I have read this Agreement, fully understand its terms, understand that I have given up substantial rights
by signing it, and sign it freely and voluntarily. I acknowledge that I have received valuable consideration
in relation to my execution of this Agreement, which I understand to be a prerequisite to my receipt of
Services. Finally, I understand that this Agreement shall be of full force and effect as to any and all
Services I receive from the Re- leased Parties, without regard to the date or timing of such service.

Signature: Date:

Print Name:

Participants Name if Different from above:


2019-2020 Cooper International Academy Application Form

INTERNATIONAL WIRE TRANSFER

1)Bank Name is Wells Fargo
2)SWIFT/BIC Code for Wells Fargo is WFBIUS6S
3)Bank address, city & state is: (1 Montgomery Street, San Francisco, CA, 94104, USA)
4)Beneficiary Account Number 2635333111
5)Beneficiary Name: Dream Builders Integrated, Inc dba Cooper International Academy
Company Address: 2664 Applewood Dr., Ontario, CA 91761