Registration form identification camp cost: $25. 00
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REGISTRATION FORM IDENTIFICATION CAMP COST: $25.00 (Including HST) The registration fee will guarantee the participant a total of 1.5 hours of ice time. Please complete and forward registration form along with payment to: Make cheque payable to: ATLANTIC HOCKEY GROUP P.O. Box 1481, Moncton, N.B., E1C 8T6 Fax: (506) 854-8200 tel.: 1 (888) 421-0000 [ ] VISA [ ] Mastercard [ ] AMEX # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration date: ____ / ____ Card Holder Name: ____________________________ Cancellation Players who voluntarily leave a tryout session or are expelled for disciplinary reasons will not be refunded. Program: Nova Scotia AAA Series Level:PLAYER INFORMATIONName: _______________________________________ (Please Print) Mailing Address: ______________________________ City: ________________________________________ Province: _________ Postal Code: ______________ E-mail: ______________________________________ Tel No: (Home) _______________ (Work) ___________ Age: _________ Date of Birth: __________________ (Day / Month / Year) Father: _________________ Mother: ______________ Medicare Number: ____________________________ Current Team : _______________________________ Position: __________ Shoots: ____ Left ____Right I / we hereby release Charlie Bourgeois Hockey School Inc., its officers, employees and agents from all liability, claims, causes of actions of any kind whatsoever, in respect of damages I / (my child) may suffer as a consequence of my child sustaining personal injury, death or property damage or loss while participating in programs and activities of the Charlie Bourgeois Hockey School Inc. And I / we do hereby agree to indemnify and hold harmless Charlie Bourgeois hockey School Inc., its officers, employees, or agents from any and all claims, demands, causes of actions of any kind whatsoever, including those involving negligence on the part of Charlie Bourgeois Hockey school Inc. or any of its officers, employees or agents that may be made or initiated by, or on behalf of my child, arising out of or connected with my said child’s preparation for or participation in any of the Charlie Bourgeois Hockey school Inc. programs of activities. ___________________________ Authorized by Parent or Guardian For office use only Date Deposit Balance Directory: wp-content -> uploads -> 2015 2015 -> Police Militarization 2015 -> 2015 ihbb championships: hs history Bowl Round 4 – Prelims First Quarter 2015 -> Wrtp/big step · 3841 W. Wisconsin Ave., Milwaukee, wi 53208 2015 -> Rao bulletin 1 December 2015 html edition this bulletin contains the following articles 2015 -> Darton College 2015 -> Training Workshop on Planning and Implementation of Multi-Sectoral Development Programme (MsDP) in Bihar Date : 6th 2015 -> Rao bulletin 15 June 2015 html edition this bulletin contains the following articles 2015 -> Rao bulletin 1 September 2015 html edition this bulletin contains the following articles 2015 -> Rao bulletin 1 August 2015 html edition this bulletin contains the following articles 2015 -> Science, and transportation united states senate Download 95.03 Kb. Share with your friends:
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