RHHS HOSA Member Application

Health Occupational Students of America (HOSA) Canada is an organization that provides high school
students with the opportunity to develop their medical knowledge, skills, and leadership through
competition in a wide variety of events on a national and international level. RHHS HOSA hopes to help
aspiring future healthcare practitioners gain experience in the healthcare community and affiliate with the
medical world.
HOSA Canada requires a $45 registration fee per student, and RHHS HOSA will be charging an additional
$5 club fee to cover training expenses. Please attach a $50 cheque made payable to Richmond Hill High
School. If your application is rejected, the payment will be returned to you at the first afterschool meeting
on Thursday, October 2, 2014 in Room 2011. Further waivers and permission forms will be sent out to
RHHS HOSA members for upcoming provincial and international competitions. Please note that there will
be additional fees for these events, but the club will do their best to fundraise and lower costs.
Please ensure that you are prepared for this financial and time commitment prior to submitting your
application. Attendance at weekly Thursday afterschool meetings is mandatory for all members. If you
have any further questions or concerns, please contact richmondhillhosa@gmail.com. Thank you and good
luck!
Contact Information:
Name: ____________________________
Grade: ____ Phone Number: _____________________
E-mail Address: ________________________________________________
Emergency Contact Information:
Name: ____________________________
Relationship: ____________________________________
Phone Number: ________________________________
Please list all of the extracurricular activities you are involved in, as well as any current executive positions
you hold.
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1. Why do you want to become a member of RHHS HOSA?
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Jessie W. Malini H. Bob L. Dennis F. Elliott C. Jiwoo J. Hillary L. Ray L. Kevin K. Melodie K. Merlyn I.

RHHS HOSA Member Application

2. How would you describe the relationship between science and medicine?
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3. RHHS HOSA will be offering the following competitive events for the 2014-2015 school year. Please
list your top 3 events in descending order of preference. Information about the different events can be
found on the HOSA Canada website at http://www.hosacanada.org/events.php. If you have chosen to
compete in a team category, please list the name(s) of your partner(s).
Medical Spelling
Forensic Medicine
Physical Therapy
Medical Math
Health Education
Sports Medicine
Medical Terminology
HOSA Bowl
Veterinary Science
Knowledge Test
Clinical Nursing
CPR / First Aid
Biomedical Debate
Dental Science
Creative Problem Solving
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With my signature, I, ________________, certify that the information presented in this application is
correct and a reflection of my honest opinion. I also understand the responsibilities and duties that I will be
taking on as a RHHS HOSA member and will be fully dedicated to them.
Applicant Signature: ________________________________

Date: __________________________

Parent / Guardian Signature: __________________________

Date: __________________________

Please return completed form to the Science Office (Room 2012) by 3:45pm on Friday, September
26, 2014. Late submissions will not be considered.

Jessie W. Malini H. Bob L. Dennis F. Elliott C. Jiwoo J. Hillary L. Ray L. Kevin K. Melodie K. Merlyn I.