Date of Birth (dd/mm/yy): Age: Male Female
Address: City/Province: Postal Code:
Home Phone: Work Phone:
SELKIRK COLLEGE SAINTS
MENS HOCKEY SKILLS CLINIC
REGISTRATION FORM:
JR.NOVICE Level: 1st year 2nd year Jan. 2-4, 12:00pm - 1:15pm
SR.NOVICE Level: 1st year 2nd year Jan. 2-4, 12:00pm - 1:15pm
ATOM Level: 1st year 2nd year Jan. 2-4, 1:30pm - 2:45pm
PEEWEE Level: 1st year 2nd year Jan. 2-4, 1:30pm - 2:45pm
T-shirt size:
Youth: small med large x-large Adult: small med large x-large
ATHLETICS &
RECREATION
301 FRANK BEINDER WAY, CASTLEGAR BC V1N 4L3
Within Reach. Beyond Imagination. 1 888 953 1133 selkirk.ca
Cost: $75.00 (GST included)
Last Name: First Name:
Parent/Guardian First and Last Name:
Most used email address:
Allergies/Medical Conditions:
Emergency Contact and Telephone:
Medical Number:
Payment Information: Visa Mastercard Cheque Cash Payment Amount:
Credit Card Number: Expiry Date:
REGISTRATION INFORMATION:
Registrations can be emailed to: kmartin1@selkirk.ca or dropped o at the
Castlegar campus gymnasium oce (250-365-1292).
CAMP INFOLINE & REGISTRATION DESK: 250-365-1447
Registration Deadline is Dec 17, 2019
LIMITED SPACES AVAILABLE
Please include a signed waiver with application form.
GOALTENDER:
The Selkirk Saints Camps and Selkirk College Athletic Program take pride in providing a safe environment for all athletes and camp
students. All possible eort is made to provide equipment and facilities that are clean and in good working order. Activities, games,
matches and exercises related to any program, athletic event or summer camp are designed to be appropriate and will include
qualied and respectable personnel. The Selkirk Saints Camps and Selkirk College Athletic Program recognize that with any athletic
activity there is a certain level of risk and that some circumstances are unpredictable and impossible to control or foresee. Your
signature at the bottom of this form will conrm that you have read and understood the following statements.
Waiver Statement for Camp Participant:
I/We, the undersigned, for ourselves, our heirs, executors and administrators, waive, release and forever discharge Selkirk College
and it’s sta, ocers, agents, employees, representatives, successors and assigns from any and all liability, claims, demands, actions
and causes of actions whatsoever arising out of or related to any loss, personal injury, including death or property damage that may
be sustained or occur during participation in the Selkirk Saints Camp or activities while at camp.
I/We voluntarily assume full responsibility for any risk, loss, damage or personal injury, including death that may be sustained as a
result of such activity.
I/We, the undersigned, give permission to Selkirk College to collect video footage, photographs and/or testimonials for promotional
purposes. I/We understand that this media may be used for the purpose of public information and/or education and may appear in
brochures, newspapers, exhibits or related Selkirk College publications.
SELKIRK COLLEGE SAINTS
MENS HOCKEY SKILLS CLINIC
CAMP PERMISSION
& WAIVER FORM
ATHLETICS &
RECREATION
301 FRANK BEINDER WAY, CASTLEGAR BC V1N 4L3
Within Reach. Beyond Imagination. 1 888 953 1133 selkirk.ca
Please initial here if you DO NOT give permission for your child to be included in video footage, photos and/or
testimonials to be collected for promotion purposes.
Please Print Name
Parent/Guardian Signature
Please Print Full Name of Parent/Guardian
Relation
Date
click to sign
signature
click to edit
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