Outstanding Achievement Recognition Application Form

The Outstanding Achievement Recognition Program has been established to bring Municipal recognition to Spruce Grove individuals/ teams/ groups and organizations who have accomplished outstanding achievements in the fields of athletics, fine arts, academics, and cultural activities. It provides and opportunity to celebrate the achievements, as a community, with pride.

Please direct inquires and application to: City of Spruce Grove, Community & Protective Services Department 315 Jespersen Avenue, Spruce Grove, AB, T7X 3E8 ------

1. NAME OF INDIVIDUAL OR GROUP TO BE RECOGNIZED:

PARKLAND WARRIORS CLUB (If application is to be made for a group, use list the back of this page)

Individual’s Name:

Address:

Phone: (Home) ______(Work)______

2. FOR TEAMS, PLEASE LIST: a) # of local participants ( Spruce Grove Residents ) 10

b) # of non local participants 4

3. TYPES OF COMPETITION/ EVENT:

Visual Arts Performing Arts Literary Arts Athletics Academics Other Gymnastics (List type)

4. NAME OF COMPETITION/ EVENT: 2012 Cup Floorball Championship

5. LEVEL: Provincial National International Invitational

6. NAME OF ORGANIZATION WHICH SANCTIONS/RECOGNIZES EVENT:

Floorball Canada Phone: 1-416-970-2529

7. PLACEMENT/AWARD RECEIVED: Gold Medal Champions (Bantam Division)

8. DATE RECEIVED: May 20, 2012 LOCATION: Toronto,

9. CONTACT FOR FURTHER INFORMATION: Barb Morin/Kevin Thibault

Address:

Phone: (Home)______(Work)______(Fax)______

E-mail Address:

Date: June 26, 2012 Signature: Signed original on file

Participant’s Name 1. Justin Berget 2. Josh Borynec 3. Rhett Dempsey 4. Bryce Edwards 5. Cody Gamble 6. Chase Hawkins 7. Tyler Hollett 8. Kyle Kause 9. Edward McDonald 10. Scott Morin (Named Most Valuable Player) 11. Dayton Murray 12. Tyler Sonnichsen 13. Evan Tellier 14. Parker Tobin 15. Brayden Wujick 16. 17. 18. 19. 20.

List all coaches, trainers and managers here (identify position):

Name Position 1. Kevin Thibault Head Coach 2. Shawn Murray Assistant Coach 3. Nathan Dempsey Assistant Coach 4.