2012 SPRING HOCKEY SKILLS CAMP REGISTRATION FORM

Sunday Evenings April 15, 22, 29, May 6, 13 @ Castledowns Arena

Pre-Novice 4 - 5 p.m., Novice 5 - 6 p.m., Atom 6:15 - 7;30 p.m., Pee Wee/Bantam 7:45 - 9 p.m., Goalies 7:45 - 9 p.m.

Mail Registration Form to:

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

PLAYER NAME:________________________________________________________________ SPRING CAMP (circle) 1 2 3 4 5

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?____________________________________________________________________________

Camp (Circle): 1 2 3 4 5 $______________

5% GST: +___________________________(GST Reg #: 88216 5723 RT0001)

TOTAL COST: = $____________________________

PAYMENT:

Cheque______ (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 and is fully aware of the cancellation policy. All skaters must wear full CSA Approved hockey equipment and bring a stick.

DATE:__________________________ SIGNATURE (Parent or Guardian):__________________________