Power Hockey Development Inc.
The Hockey Training Company
PRINT HERE (right click & select print)
Fax to 416-636-8772
Pay Online using Credit Card - see PHD Web Store tab
Mail Application to:
12 Lismer Cres.
Bolton, ON L7E 2L9
Please Circle to select desired Program Below:
Prospects or CHG Summer League
ADDRESS: __________________________________________APT: _______
POSTAL/ZIP: ______________ BIRTH DATE: _____________________AGE: _______
TEL(H): ____________________TEL(W): __________________
HEALTH CARD #: ___________________________________
Past Season/Current Team: _____________________________ Position ____________
Stats (Goals/Asst/Pts) _________________________ School/Grade:______________________
OHL Rights __________________ Year Selected in OHL Draft ___________
Have you written your SAT's: YES or NO SAT Score: __________
GRADE Average: ___________
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: ____________________