Kelowna Adult Goalie Camp

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Registration for July 12-14, 2019

Email *

Your Full Name *

What Level Of Hockey Are You Currently Playing *

Junior

Senior

Rec League

Not playing anymore but would like to get back into it

Old Timers

Never played goal before but want to learn

None of the above

Other:

What is the highest level of goal you have played? *

Mites

Novice

Atom

Pee Wee

Bantam

Midget

Junior

College/University

Senior

Minor Pro

NHL

Never played goal before

Birth Date *

YYYY

Phone Numbers *

Emergency Contact Name & Number *

Any Allergies or Medical Issues *

Health Care Number *

Goalie Jersey Size *

XXL

XXXL

I grant permission to Top Goaltending, Larry Moberg and Jamie Bastien to publish any and all publications for any lawful purpose including, without limitation, publicity, illustration, advertising, and Web content. *

Yes

I, THE PARENT/GUARDIAN OF THE ABOVE NAMED PLAYER, HEREBY GIVE MY APPROVAL FOR HIS/HER PARTICIPATION IN THE ABOVE NAMED ACTIVITY DURING THE CURRENT SEASON. I ASSUME ALL RISKS INCIDENTAL TO THE CONDUCT OF THE ACTIVITY AND TRANSPORTATION TO AND FROM THE ACTIVITIES. I DO HEREBY RELEASE, ABSOLVE AND HOLD HARMLESS THE ORGANIZERS OF THE ACTIVITY, SPONSORS, SUPERVISORS, AND ANYONE CONNECTED WITH THE PROGRAM. IN CASE OF INJURY TO THE ABOVE NAMED CHILD, I HEREBY WAIVE ALL CLAIMS AGAINST THE ORGANIZERS AND SUPERVISORS OF THE ACTIVITY. *

Yes

Today's Date *

YYYY

Send me a copy of my responses.

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