Skills Plus Hockey Registration Form

Skills Plus Hockey 259 Stanley Dr. , Waterloo, ON - N2L 1H9 email: eric@skillsplushockey.com
Spring/Summer 2010 Registration Form
Name: ____________________________________________________________ Address: __________________________________________________________ City: _____________________________ Postal Code: _______________ Birth Date: _____________________________ Gender: Male / Female (circle one) Parent Name(s): ___________________________________________________________ Telephone: Home: _____________________ Work: ______________________ Email Address: _________________________________________ Level:______________________________Position:______________________ AAA/AA/A/MD/House League Medical Information (i.e.allergies, asthma, etc.)______________________________________________ Signature:________________________________________________ Date:__________________________ Print Name: ______________________________________
Please identify the selected program(s) by circling the appropriate numbers. March Break Camp: MB1 MB2 MB3 MB4 Weekly Child Sessions: 1 2 3 Weekly Youth / Adult Sessions: A1 A2 AY1 Junior Prospects: JP1 Poised Defensemen: PD1 PD2 PD3 PD4 Goaltending/Goal Scoring: G1 G2 G3 Elite Weekly Training: PT1 PT2 PT3 3 on 3 Training: 3on3 Summer Camps: 1A 1B 1C 2A 2B 2C 3A 3B 3C 3D 4A 4B 5A 5B 5C 5D 6A 6B 7 8A 8B 9 10A 10B 10C 10D 11A 11B 11C	Please complete the application form & send it along with payment to 259 Stanley Dr., Waterloo, N2L 1H9. Your cancelled cheque is confirmation of registration. Camp packages will be sent out three weeks prior to the start of camp. Please make cheque(s) payable to Skills Plus Hockey Inc. (admin. fee charged for cancellations). Medical reason needed. Discounts: $15 off for each additional child from same family $15 off Weekly programs registered by Apr. 1st $20 off for Camps registered before May 1st $30 off same person registered in 2nd camp (s) Goalies – 30% discount on Camps (except 2, 3 & 6) Minimum registration requires a $50 deposit and a post-dated cheque for balance payable one month prior to program start date. March Break Camp Discount – $10 discount if registered before February 9th March Break Camp – Camp information packages will bemailed out 2 weeks prior to camp. In consideration of the acceptance of the applicant in Skills Plus Hockey, the Applicant and and/or Parent(s)/Guardian(s) on behalf of the Applicant, for herself/himself, his/hers heirs, executors, administrators, and personal representatives hereby waive any claims to which the Applicant may become entitled for accident, injury, loss of damage and do release Skills Plus Hockey Inc., it's owners, officers, directors, agents, and employees from any claims for accident, injury, loss, or damages suffered by the Applicant as result of the Applicants participation in Skills Plus Hockey notwithstanding any such accident, injury, loss or damages may have risen by reason of the negligence of any one or more of the aforementioned parties. The Applicant, or Parent(s), Guardian(s) on behalf of the Applicant, Hereby states that the Applicant is in proper physical condition to participate in Skills Plus Hockey and is aware that participation could in some circumstances, result in physical injury.
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