Printable - Canadian Super Camp

ESTEVAN, SASKATCHEWAN, CANADA
REGISTRATION FORM (REGISTRATION DEADLINE MAY 31, 2015)
FLECKS CANADIAN SUPERCAMP
Name _____________________________
LAST
Parent _________________________
FIRST
Address_______________________________________________________________________
CITY
PROV
POSTAL CODE
EMAIL _______________________________ Phone _____________________________
Birthdate _______________________
MONTH
_______
_______
_______
DAY
Skater Camp
_______
July 20 – July 25
$525.00
August 3 – August 8 $525.00
$475.00
$525.00
$150.00
$150.00
$10.00
Goaltender Camp
_______
_______
(all fees include GST)
Jersey Size (Circle)
Youth M
Name_______________________
___
___
___
___
___
Position__________ Last Team_____________
YEAR
L
July 27 – August 1
$525.00
Shooters (9 yrs & up) $150.00
XL
Adult S
M
No. _______________
L
XL
2XL
Early Bird - Full Payment by Feb 15/15
No late payments accepted.
Full Payment after Feb 15/15 or
Deposit enclosed
____ Balance post dated June 30, 2015
Shooter Session
Personalized jersey
____ $20.00 FlxFit Socks – Height ________*
* Flx Fit Socks are the custom socks(optional) that are made to match the jersey the participant receives at the
camp. Due to the stretch feature of these socks the full height of the participant is needed for a proper fit.
Make checks payable to: Flecks Hockey
_____ Visa
______ Mastercard
Card No: ______________________________
Credit card payment for full amount.
Expiry Date ____ ___
Month
Year
CRV _________
3 nos. off back
Cardholder Name: ___________________________
Health Care #
Medical Information:
List any food allergies:
CANELLATION AND REFUND POLICIES
- A $150 deposit must accompany all applications. Balance of fee must be paid by June 30, 2015
- There will be no refunds or cancellations after 6/30/15 unless it is for medical reasons. In such a case, a Doctor’s certificate must be presented
to verify the condition
- There will be a $50 non-refundable service charge for ALL cancellations
- If a player does not attend, or leaves during the week there shall be no refund.
I/WE the undersigned being the parent(s) or guardian(s) of the above named player do hereby consent to the said child participating in all the
activities of this hockey school and do hereby release, absolve and indemnify all coaches and staff of Flecks Hockey Inc. from any claim which I/
We, or the said child may have as a result of his participation. I/We do assume all risks and hazards incidental to the above article and hereby
waive all claims whatsoever against the above named company or individuals.
Signature of Parent or Guardian:
FOR MORE INFORMATION: Allan or Peggy Fleck Cell (306)577-9872
Fax (306)577-4749
email: fleckextreme@hotmail.com
Mail form with payment to: Flecks Hockey Box 902, Carlyle, SK S0C 0R0 Canada