WAIVER OF LIABILITY
MUST BE COMPLETED FOR EACH PARTICIPANT
Novice - Atom
Pee Wee - Bantam
Participant's Name [s]:
_________________________________
_________________________________
Parent's Name:
_________________________________
Street Address:
_________________________________
City:
_________________________________
Province:
_________________________________
Postal Code:
_________________________________
Birthdate [s]:
_________________________________
Telephone:
_________________________________
Alternate or Cell Phone:
_________________________________
Parent's Email Address:
_________________________________
Health Card Number:
_________________________________
Medical Problems - Allergies:
_________________________________
Clinic[s] Required:
_________________________________
_________________________________
_________________________________
SUMMER CLINIC JERSEY SIZE [s]:
Please Insert Quantity [s]
Youth-S ___ Youth-M ___ Youth-L ___
Youth-XL ___ Adult (?) ___
Payment Methods:
Cash . Cheque . Money Order
$100 Deposit or Full Payment Is Required For Fall Clinics
Balance Required By June 1 – 2012
BEFORE
Fall Clinics Begin
We Have Waiting Lists So All
Participants
Must Confirm Payment By June 1 Please
Fax REGISTRATION Form To: 519.869.6757
WAIVER OF LIABILITY
MUST BE COMPLETED FOR EACH PARTICIPANT
I agree that this registered player is physically fit to participate in this program and has no medical conditions which restrict their participation.
I further agree that participation in this hockey school exposes the participant to significant risks of personal injury.
As the parent or legal guardian of the player, I am aware of the risks, and voluntarily and knowingly recognize, accept and assume this risk.
I hereby release Todd Bidner, Skill Shots Incorporated, its employees and affiliates from any and all claims for damages or injuries in any way connected with the participants in the program.
In the event the player is injured, I give Todd Bidner and Skill Shots Incorporated permission to seek medical or dental treatment.
I further agree to hold Todd Bidner and Skill Shots Incorporated harmless for lost or stolen articles of property.
I grant Todd Bidner and Skill Shots Incorporated the right to use all photos or video footage of the player for any and all instructional or promotional purposes.
I further understand that this release is binding upon my heirs, executors and assignees.
I acknowledge that this is a high intensity athletic program and accept all of the risks with the association of the participation in such a program.
I acknowledge that once the courses begin that partial refunds are not available due to missed clinics by participant(s).