Briercrest 3 on 3 Hockey

First Name:
Last Name
P.O. Box/Street
City:
Prov/State:
Postal/Zip Code:
Telephone:
Email:
Years played:
Last team played for:
Position played:
Date of Birth:
Sex:Male Female
 
Jersey Size (youth sizes):
Small Medium Large X-Large
 
 
Initiation ($140)
All Others ($280.00)
 
Parental Consent Form
I hereby authorize the staff of Briercrest College and Seminary to act for me according to their best judgement in any emergency requiring medical attention, and I hereby waive and release Briercrest Family of Schools of any and all liability for any injuries or illness incurred at 3-on-3 hockey. I have no knowledge of any physical impairment that would be affected by the athlete’s participation in the 3-on-3 program.


3 on 3 Hockey Waiver
I agree to allow Briercrest College and Seminary to take pictures of my child while they are attending 3 on 3 Hockey. I understand that the pictures will be used for future brochures and print and web-related publicity for the school.

No, I do not agree to allow Briercrest College and Seminary to take pictures of my child while they are attending 3 on 3 Hockey.
 
Name of Parent/Guardian:
Contact Phone #:
Provincial Health Card (name on card):
Provincial Health Card #:
Additional Medical Insurance #:
Type of Medical Insurance:
What medical conditions should we be aware of:
This is my first time at Briercrest 3 on 3 Hockey and I was invited by:
 
Payment Method: Credit Card Cheque
 
If you wish to pay by credit card please fill out the following information:
Name as on Card:
Card Type: Visa Mastercard
Card Number:
Expiry Date:

Your registration will NOT be final until payment is received and confirmed.
You will receive a confirmation letter.

If paying by cheque, please make cheques payable to:

Briercrest College and Seminary

Mail to:
Briercrest College and Seminary

attn: Accounting Department
510 College Drive,
Caronport, SK S0H 0S0

 
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