Application Form
Name: ___________________________
Date of Birth: _____________________
Health Card #_____________________
Address: _________________________
_________________________
Postal Code: ______________________
Phone: __________________________
E-mail: __________________________
Position__________________________
Enrollment limited to 36 per group, no post-dated cheques accepted. No refunds or cancellations.
Waiver
I acknowledge that hockey is a contact sport and Gagne Hockey Development, it’s coaches and staff, shall not be liable for any injuries or damage incurred while participating in the camp or on the premises at which the the camp is held. Furthermore, I submit that any relative, heir legal relative from making Gagne Hockey Development, it’s coaches and staff, liable for any injury or damage that may occur during or on the premises of the camp. I certify the above enrollment is true, and grant permission for the hockey school staff to provide medical transportation or first aid if needed.
Signature of Parent/Guardian __________________________
Print Name of Parent/Guardian ________________________
Date: _____________________________________________
Mail completed application form with cheque payable to: Gagne Hockey Development or by PayPal:
Gagne Hockey Development
271 Mont Sacre Coeur Crescent
Timmins, Ontario
P4N 6M5