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Power Hockey Development Inc.

The Hockey Training Company

Registration Form

POWER HOCKEY CAPITALS

SUMMER HOCKEY & PROSPECTS TEAMS

TO PRINT YOUR REGISTRATION FORM: (Press Right Click on Mouse)

PERSONAL INFORMATION: (please print)

PLAYER’S NAME: ____________________________________________________

ADDRESS: ________________________________________________APT: _______

CITY: ______________________________PROV/ST: ______________________

POSTAL/ZIP: ______________ BIRTH DATE: _____________________AGE: _______

TEL (H): ____________________TEL (W): __________________

EMAIL: _________________________________________________

MEDICAL INFORMATION:

EMERGENCY CONTACT NAME: _______________________________

NUMBER: ___________________________

MEDICAL CONDITIONS: ___________________________

HEALTH CARD #: ____________________________________

HOCKEY INFORMATION:

TEAM: ________________________ POSITION: _____________

LEVEL: _______________

POWER HOCKEY TEAM:

(Please indicate which team you are playing for)

PROSPECTS: ________________ OR SUMMER TEAM: ____________

PAYMENT OPTIONS (Please Cirlce)

- Cash

- Cheque*

- Money Order

* Please make cheques payable to: POWER HOCKEY DEVELOPMENT

Please enclose payment with application and send to:

POWER HOCKEY DEVELOPMENT

130 Maniza Rd

TORONTO, ONTARIO

M3K 1S3


CANCELLATION POLICIES:

Registration must be accompanied by a full payment. We cannot offer refunds, program substitution or credit for cancellations after April 1, 2008. Any cancellations made prior to that date, will receive full refund less $ 150.00.

Release of Liability & Waiver Agreement:

I give my approval to my Childs participation in Power Hockey Development activities and agree that Power Hockey Development, its proprietors and employees will not be responsible for any accident or loss however caused and agree to release the proprietors from all claims and damages which may arise as a result of such accidents or loss. In the event of inability to contact me, I hereby give you permission to seek out any necessary medical assistance my child requires while attending your program. In signing the application, I hereby acknowledge that I have read and understand the conditions and certify that the applicant is in good physical and mental health.

Parent's/Guardian's Name: _________________________

Parent's/Guardian's Signature: _________________________

Date: ___________________

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