Empower Hockey - 2024 Spring Programs
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Adresse e-mail *
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Parent's FIRST Name *
Parent's LAST Name *
Athlete's FIRST Name *
Athlete's LAST Name *
Athlete's YEAR OF BIRTH

Adult
U18 – 2007, 2008, 2009
U15 – 2010, 2011
U13 – 2012, 2013
U11 – 2014, 2015
U9 – 2016, 2017
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Athlete's ASSOCIATION *
Which PROGRAM are you registering for?

Goalie World (All ages, adults welcome!)
9:30-10:30am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 18)
Burnaby Winter Club - NHL Rink

U9/U11
9:30-10:30am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 18)
Burnaby Winter Club - NHL Rink

U13/U15/U18 Minor
7:00-8:00am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 18)
Burnaby Winter Club - NHL Rink

U18 (BCEHL / CSSHL / JWHL)
8:15-9:15am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 19)
Burnaby Winter Club - NHL Rink
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Which Goalie World SESSIONS are you registering for?

Goalie World - $75 + GST per session
1 session = $78.75
2 sessions = $157.50
3 sessions = $236.25
4 sessions = $315.00
5 sessions = $393.75
6 sessions = $472.50
7 sessions = $551.25
8 sessions = $630.00

9:30-10:30am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 18)
Burnaby Winter Club - NHL Rink
Which U9/U11 SESSIONS are you registering for?

U9/U11 - $50 + GST per session
1 session = $52.50
2 sessions = $105.00
3 sessions = $157.50
4 sessions = $210.00
5 sessions = $262.50
6 sessions = $315.00
7 sessions = $367.50
8 sessions = $420.00

9:30-10:30am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 18)
Burnaby Winter Club - NHL Rink
Which U13/U15/U18 Minor SESSIONS are you registering for?

U13/U15/U18 Minor - $65 + GST per session
1 session = $68.25
2 sessions = $136.50
3 sessions = $204.75
4 sessions = $273.00
5 sessions = $341.25
6 sessions = $409.50
7 sessions = $477.75
8 sessions = $546.00

7:00-8:00am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 18)
Burnaby Winter Club - NHL Rink
Which U18 (BCEHL / CSSHL / JWHL) SESSIONS are you registering for?

U18 (BCEHL / CSSHL / JWHL) - $65 + GST per session
1 session = $68.25
2 sessions = $136.50
3 sessions = $204.75
4 sessions = $273.00
5 sessions = $341.25
6 sessions = $409.50
7 sessions = $477.75
8 sessions = $546.00

8:15-9:15am Sat Apr 6 to Sat Jun 1
8 sessions available (no May 19)
Burnaby Winter Club - NHL Rink
If you'd like to purchase an Empower Hockey jersey, please add $25 + GST = $26.25 to your total amount.

**Jerseys must be ordered before Mar 11**

Athlete's JERSEY SIZE:

Small – smaller U15s
Medium – some U15s, some U18s
Large – some U15s, some U18s

Goalie Junior – smaller goalies
Goalie Intermediate – most U13s
Goalie Adult – most U15s and U18s
Effacer la sélection
STEP ONE - Count your total number of sessions and check what the total amount is.
STEP TWO - If you are purchasing a jersey, add $26.25 to that amount.
STEP THREE - E-transfer your total amount to empowerhockey@gmail.com.
STEP FOUR - Record your transaction REFERENCE NUMBER below.
STEP FIVE - Finish and submit this form to secure your spot!

***Your registration cannot be accepted until the e-transfer has been completed***
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How did you hear about Empower Hockey? *
Are you NEW to our Empower Hockey programs or a RETURNING athlete? *
Emergency Contact FIRST & LAST NAME *
Emergency Contact PHONE NUMBER *
Acknowledge of Risk and Responsibility and Informed Consent

Informed consent of parent or guardian acknowledgement of risk and responsibility form for children under the age of 19 WARNING: PLEASE READ CAREFULLY BEFORE SIGNING I, (Parent or Legal Guardian), on behalf of the Minor Participant acknowledge the following: - I am aware that the Minor Participant named above (the "Minor") will be participating in physical fitness activities solely at my own discretion and the discretion of the Minor. Those activities could include all activities, events, or services provided, arranged, organized, conducted, sponsored, or authorized by Empower Hockey Ltd (the "Company"), including without limitation: indoor ice hockey, indoor ball hockey, indoor floor hockey, indoor inline hockey, outdoor ice hockey, outdoor ball hockey, outdoor street hockey, outdoor inline hockey, training, running, weight lifting, throwing objects, banded exercises, multi-player games and activities, stretching, observing others engaged in these activities, school and instructional sessions, transportation to and from training facilities, and all other activities, events, and services in any way connected with or related to those activities (collectively, the "Hockey & Fitness Activities"). - I UNDERSTAND THAT PARTICIPATION IN THE HOCKEY & FITNESS ACTIVITIES CAN BE HAZARDOUS AND MAY INVOLVE THE RISK OF PHYSICAL INJURY OR DEATH. I acknowledge that participation in the Hockey & Climbing Activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to me or the Minor, to my or the Minor's physical property, or to third parties. I understand that those risks cannot be eliminated without jeopardizing the essential qualities of the Hockey & Fitness Activities. The risks include but are not limited to: scrapes, cuts and bruises; falling off of equipment; muscle and joint sprains and strains; broken wrists, ankles, legs, and other bones; participants falling and falling on each other resulting in broken bones and other serious injuries including death; participants failing to wear their equipment; participants failing to wear their equipment properly; participants failing to play or train safely or within one’s own ability; failure to act safely on the part of instructors or supervisors or other participants; failure of hockey or training equipment including protective hockey gear, pucks, hockey nets and pegs, hockey sticks, cones, ropes, bands, medicine balls, flying discs, hacky sacks, soccer balls, flag football gear, hecostix, tennis balls, buckets, or any other equipment associated with or related to the Hockey & Fitness Activities; and misuse of any of the aforementioned equipment; failure of hockey rinks or any other training facilities and surfaces including but not limited to: ice and floor hockey rinks, hockey rink dressing rooms, outdoor grass fields, outdoor turf fields, outdoor tracks, outdoor gravel surfaces, outdoor pavement or cement surfaces, outdoor paths and trails, and all other training facilities and surfaces; and in the context of outdoor training, in addition to the injuries and risks listed above, include but are not limited to: trips arising from walking on uneven terrain, falling with or without equipment attached, falling medicine balls or other objects, weather which may cause injury due to extreme heat, cold or lightning, wild animals, insect bites, hazardous plant life, and transport by public or private vehicles to and from the activity site. - I am not aware of the Minor having any existing health, mental, or physical conditions that may increase his or her risk in participating in the Hockey & Fitness Activities. - I UNDERSTAND PARTICIPATING IN THE HOCKEY & FITNESS ACTIVITIES COULD RESULT IN THE MINOR’S INFECTION WITH THE COVID-19 VIRUS, WHICH COULD INVOLVE FLU-LIKE SYMPTOMS, RESPIRATORY PROBLEMS, ORGAN FAILURE, PERMANENT DISABILITY, OR DEATH. I agree that I will not permit the Minor to participate in any of the Hockey & Fitness Activities, if: (1) to the best of my knowledge and awareness, the Minor is experiencing, or has experienced in the prior 14 days, flu-like symptoms or symptoms of any transmissible viral or bacterial infection or disease; or (2) to the best of my knowledge and awareness, the Minor has been in contact in the prior 14 days with any person diagnosed with the COVID-19 virus. I will not permit the Minor to participate in any Hockey & Fitness Activities if I have been advised by the Minor, the BC Centre for Disease Control, any government agency, or the Minor’s doctor to physically isolate due to possible exposure to COVID-19. - The Minor has been informed that he or she must follow the rules and instructions communicated by the Company and its staff. - I understand that if the Minor does not follow the Company’s rules and instructions, he or she might lose their privilege to participate in the Hockey & Fitness Activities. - I understand that putting on hockey equipment or any other training equipment is unsupervised and that a Minor is permitted to do these tasks and is solely responsible for properly doing them. - In permitting the Minor to participate in the Hockey & Fitness Activities, I am not relying on any oral, written or visual representations or statements made by the Company or their directors, officers, employees, instructors, agents, or representatives or any other inducement. - Based upon my understandings and acknowledgements described herein, I give the Minor permission to participate in the Hockey & Fitness Activities.


OR IF AN ADULT:

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK WARNING AND INDEMNIFICATION AGREEMENT

WARNING: PLEASE READ CAREFULLY BEFORE SIGNING! 

BY SIGNING THIS AGREEMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT 

I acknowledge the following:

·      I will be participating in physical fitness activities solely at my own discretion. Those activities could include all activities, events, or services provided, arranged, organized, conducted, sponsored, or authorized by Empower Hockey Ltd (the "Company"), including without limitation: indoor ice hockey, indoor ball hockey, indoor floor hockey, indoor inline hockey, outdoor ice hockey, outdoor ball hockey, outdoor street hockey, outdoor inline hockey, training, running, weight lifting, throwing objects, banded exercises, multi-player games and activities, stretching, observing others engaged in these activities, supervision of children by parents or guardians, school and instructional sessions, transportation to and from training facilities, and all other activities, events, and services in any way connected with or related to those activities (collectively, the "Hockey & Fitness Activities").

·      I UNDERSTAND THAT PARTICIPATION IN THE HOCKEY & FITNESS ACTIVITIES CAN BE HAZARDOUS AND MAY INVOLVE THE RISK OF PHYSICAL INJURY OR DEATH. I acknowledge that participation in the Hockey & Climbing Activities entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to me or the Minor, to my or the Minor's physical property, or to third parties. I understand that those risks cannot be eliminated without jeopardizing the essential qualities of the Hockey & Fitness Activities. The risks include but are not limited to: scrapes, cuts and bruises; falling off of equipment; muscle and joint sprains and strains; broken wrists, ankles, legs, and other bones; participants falling and falling on each other resulting in broken bones and other serious injuries including death; participants failing to wear their equipment; participants failing to wear their equipment properly; participants failing to play or train safely or within one’s own ability; NEGLIGENCE or failure to act safely on the part of instructors or supervisors or other participants; failure of hockey or training equipment including protective hockey gear, pucks, hockey nets and pegs, hockey sticks, cones, ropes, bands, medicine balls, flying discs, hacky sacks, soccer balls, flag football gear, hecostix, tennis balls, buckets, or any other equipment associated with or related to the Hockey & Fitness Activities; and misuse of any of the aforementioned equipment; failure of hockey rinks or any other training facilities and surfaces including but not limited to: ice and floor hockey rinks, hockey rink dressing rooms, outdoor grass fields, outdoor turf fields, outdoor tracks, outdoor gravel surfaces, outdoor pavement or cement surfaces, outdoor paths and trails, and all other training facilities and surfaces; and in the context of outdoor training, in addition to the injuries and risks listed above, include but are not limited to: trips arising from walking on uneven terrain, falling with or without equipment attached, falling medicine balls or other objects, weather which may cause injury due to extreme heat, cold or lightning, wild animals, insect bites, hazardous plant life, and transport by public or private vehicles to and from the activity site.

·      I agree to assume responsibility for maintaining control at all possible times while engaging in the Hockey & Fitness Activities and for reading, understanding and complying with all signage and heeding the rules and instructions of staff of the Company. I understand that putting on hockey equipment or any other training equipment is unsupervised and that I am solely responsible for properly doing these tasks. I further understand that falls and injuries are common.

·      I am not aware of having any existing health, mental, or physical conditions that may increase my risk in participating in the Hockey & Fitness Activities.

·      I UNDERSTAND PARTICIPATING IN THE HOCKEY & FITNESS ACTIVITIES COULD RESULT IN MY INFECTION WITH THE COVID-19 VIRUS, WHICH COULD INVOLVE FLU-LIKE SYMPTOMS, RESPIRATORY PROBLEMS, ORGAN FAILURE, PERMANENT DISABILITY, OR DEATH. I agree that I will not participate in any of the Hockey & Fitness Activities, if: (1) to the best of my knowledge and awareness, I am experiencing, or have experienced in the prior 14 days, flu-like symptoms or symptoms of any transmissible viral or bacterial infection or disease; or (2) to the best of my knowledge and awareness, I have been in contact in the prior 14 days with any person diagnosed with the COVID-19 virus. I will not participate in any Hockey & Fitness Activities if I have been advised by the BC Centre for Disease Control, any government agency, or my doctor to physically isolate due to possible exposure to COVID-19.

·      I acknowledge that alcohol, marijuana and other drugs – both prescribed and non-prescribed – have the capacity to impair my judgment and reduce my ability to effectively manage risks. I understand that consuming alcohol or marijuana before or during my participation in the Hockey & Fitness Activities is not permitted.

·      RECOGNIZING THESE RISKS AND DANGERS, I VOLUNTARILY CHOOSE TO PARTICIPATE IN THE HOCKEY & FITNESS ACTIVITIES AND EXPRESSLY ASSUME ALL RISKS AND DANGERS OF THE ACTIVITIES, WHETHER OR NOT DESCRIBED ABOVE, KNOWN OR UNKNOWN, INHERENT, OR OTHERWISE.

·      In consideration of the Company allowing me to participate in Hockey & Fitness Activities and permitting my use of their personal property, facilities, or equipment, I AGREE, to the greatest extent permitted by law, TO WAIVE ANY AND ALL CLAIMS AGAINST AND TO HOLD HARMLESS, RELEASE, INDEMNIFY, AND AGREE NOT TO SUE Empower Hockey Ltd, its insurer, the Company's owners, officers, directors, partners, shareholders, agents, guides, instructors, independent contractors, affiliates, volunteers, participants, employees, representatives, successors and assignees, and all other persons or entities acting in any capacity on their behalf (each of whom, along with the Company, is a "Released Party") FOR ANY INJURY, DEATH, LOSS, PROPERTY DAMAGE, OR EXPENSE, WHICH I MAY SUFFER, OR THAT MY NEXT OF KIN MAY SUFFER, ARISING IN WHOLE OR IN PART OUT OF MY PARTICIPATION IN THE HOCKEY & FITNESS ACTIVITIES, INCLUDING BUT NOT LIMITED TO ANY CLAIMS BASED ON ANY RELEASED PARTY'S: (1) ALLEGED OR ACTUAL NEGLIGENCE; (2) BREACH OF CONTRACT; (3) NEGLIGENT MISREPRESENTATION; (4) BREACH OF EXPRESS OR IMPLIED WARRANTY OR CONDITION; OR (5) BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE UNDER THE OCCUPIERS LIABILITY ACT (British Columbia). I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF ANY RELEASED PARTY TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF THE HOCKEY & FITNESS ACTIVITIES.

·      I understand the above paragraph releases all legal or equitable claims I might have against one or more Released Party, including those of which I am not aware, those not mentioned in the above paragraph, and those resulting from anything that has happened up to now.

·      I acknowledge and understand that the Company is not responsible for any lost or stolen property belonging to myself or the minor child(ren) under my care while that personal property is at any hockey rinks or any training facilities used by the Company nor at any parking lots, vehicles in parking lots, or lockers associated with those hockey rinks or training facilities or parking lots.

·      I agree that this agreement will bind and benefit my heirs, next of kin, executors, administrators, and representatives, in the event of my death or incapacity. I will not assign my rights and obligations under this agreement. 

·      The laws of the Province of British Columbia, and federal laws of Canada applicable in British Columbia, govern this agreement. The courts of the Province of British Columbia have exclusive jurisdiction over any claims arising out of this agreement. If any part of this agreement if held unenforceable, the validity of all remaining parts will not be affected.

·      In entering into this agreement I am not relying on any oral, written or visual representations or statements made by any Released Party with respect to the safety of the Hockey & Fitness Activities other than what is set forth in this agreement.

Medical Treatment: In the event of any injury or medical condition arising during my participation in the Empower Hockey Programming, I authorize the Released Parties to seek and obtain any necessary medical treatment on my behalf. I agree to be responsible for all medical expenses incurred as a result of such treatment.

Use of Likeness: I grant Empower Hockey the right to use my name, photograph, video, or other likeness in any promotional materials, website, or other media related to the Empower Hockey Programming, without further notice, compensation, or consent.

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