Application Form - Fusion Hockey 2015

Summer Camp - Application 2015
@FusionHockey
fusion.hockey
Our Program
Sackville Sports Stadium
Jun 30th - Aug 13th
Tue: 8am - 2pm Thu: 8am - 12pm
for detailed schedule visit: fusionhockey.ca
7 Weeks
17.5 hrs - On Ice Development
14 hrs - Dryland Training
4 hrs - Classroom Sessions
fusionhockey.ca
Fusion Hockey
Our Instructors
Andrew Wigginton
Dal Tigers, SMH VP Development
Jeff O’Flaherty
Head Coach Valley Wildcats Major Midget, Bantam AA SMH
Neil Pashkoski
Asst. Coach Cole Harbour Major Midget Wolf Pack
Wayne Wigginton
Coached all AAA levels in SMH
Adrienne Power
Canadian Olympian - Sprinter, Dryland Instructor
Joe Johnston
Dal Tigers Goalie Instructor
Apply for your spot today! Once all applications are received we will confirm your spot.
Players Name:
Birth Year:
Parents Name:
Address:
Division:
Level:
Position:
Phone#:
AAA
Bantam PeeWee
AA
Forward Defense
$575
$500
Early Bird
Cash Discount
$450
$450
Refer to Joe Johnston
for pricing and details
-$100
“Must be enrolled in WTT
summer off-ice program.
Spots still available.”
(due by June 2nd)
Adult S
M
M
L
L
B
Goalie
$575
$500
Jersey: Youth S
Atom
A
Cash Discount
(due by June 16)
Email:
Midget
XL
XL
Jersey# Choices
1st
2nd
3rd
I waive and release Fusion Hockey Instructors and players from any liability for any type of injuries that occur during play. I authorize league staff to
use their best judgement in an emergency requiring medical attention. I hereby certify that my child is medically fit to participate in this camp.
Parent / Guardian Signature:
Payments can be made in person on June 2nd / June 16th
Sackville Sports Stadium Conference Room
Applications & Money Transfers can also be emailed to
info@fusionhockey.ca . $100 Deposit Due by June 2nd.
Balance Due before you step on the ice June 30th.
Date:
Credit Card Payment : (Add 5%)
Other
Credit Card Type:
Name on Card:
Card #:
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