PARENTS!! Please CLICK HERE before registering.

2011 - 2012 Goalie Training Camp Registration Form

*Please make cheques and money orders payable to EDGES PSI and mail them along with this form to:

Edges P.S.I.
13017 - 137A Street
Edmonton, Alberta T5L 5A3

*or complete credit card information below and fax form to (780) 454-8400 or email to coleytr@telusplanet.net

SKATER NAME:_________________________________________________________________________

ADDRESS:______________________________ CITY:________________ POSTAL CODE:_____________

BIRTHDATE(mm/dd/yy):_________________ PH: (H)__________________ (other)____________________

PARENT'S NAME(S):______________________________ LAST LEVEL PLAYED:____________________

INJURIES OR HEALTH CONCERNS:_________________________________________________________

HEALTH CARE #:___________________________ EMAIL ADDRESS_______________________________

HOW DID YOU FIND OUT ABOUT US?________________________________________________________

TOTAL COST(With GST - GST Reg #: 88216 5723 RT0001): $_____________

PAYMENT: CASH/CHEQUE ENCLOSED ________ (*A $25 fee will be charged for all returned cheques)

Visa_____ Mastercard_____ Card #__________________________________ Expires_____________

Cardholder Name______________________________ Authorizing Signature____________________

No refunds or credits will be issued unless the program is cancelled by Superskate Advanced Hockey Development Association or Edges Professional Skating Instruction (Tammy Coley). In consideration of the benefits awarded to us by acceptance of this application, the under signed agrees to save and hold harmless and release Superskate Advanced Hockey Development Association, Edges Professional Skating Instruction, Tammy Coley, all coaches and assistants, and any private or municpal rink of and from any and all claim rising from bodily injury and property damage sustained by the student. All skaters must wear full CSA Approved hockey equipment.

DATE:____________________ SIGNATURE (Parent or Guardian):_________________________________