Roulette Russe Jeu Flash - all info here!

Registration Form
Please print these pages and complete the entire player registration and medical release
section with all information necessary. You can email it with the registration amount below to
[email protected] or alternatively mail it to:
19 Foxden Rd
M3C 2B1
North York, Ontario
PLAYER INFORMATION
PERSONAL INFORMATION
Player Name:
Email:
Date of Birth:
Phone:
Address:
Province/State:
Postal Code/ZIP:
Country:
EMERGENCY CONTACT INFORMATION
Emergency Contact:
Email:
Address:
Province/State:
Postal Code/ZIP:
Country:
Primary Phone:
Secondary Phone:
SCHOOL INFORMATION
High School:
Graduation Year:
GPA/Grades:
SAT/ACT:
HOCKEY INFORMATION
Position:
Shoots:
Height:
Weight:
Recent Team:
MEDICAL INFORMATION
Allergies:
Chronic Medical
Treatments:
LIABILITY WAIVER AND MEDICAL RELEASE
I agree that I shall provide health insurance to cover any personal injury sustained by the APPLICANT and
property damage while participating in any activities or while on the premises of the hockey camp
provided by PLAYERS FIRST HOCKEY. The undersigned assumes all responsibility for any and all risk for
damage or injury that may occur to the above named player/s as a participant in the Camp, including
practices, games, skill sessions, clinics, and other activities related to the Camp. In consideration of such,
the undersigned hereby releases and discharge PLAYERS FIRST HOCKEY its members, owners, operators,
employees, agents, supervisors, instructors and other players from all claims, demands, rights or cause
of action present or future, whether known or anticipated and resulting from or arising out of or
incident to the undersigned’s participation with the said Camp. This is also my permission to have myself
or my child admitted and attended to, for medical or dental treatment in case of sickness or injury.
x _______________________________________________________________
SIGNATURE OF PARENT/PLAYER OR GUARDIAN (player must be 18 yrs or older)
___________________________________
DATE (dd/mm/yr)
NOTE: This medical release is relative to scheduled PLAYERS FIRST HOCKEY activities in the event the
parent(s)/guardian are not present to assure medical treatment if necessary.