Participant Info:
Name *
Level of Play (During regular season) * Do Not Play YetHouseRepAA/AAA
Date of Birth *
Gender *
Medical # (OHIP)
Medical Conditions? *
Parent / Guardian Information:
Relationship to Participant *
City *
Home Phone # *
Cell / Work Phone # *
E-Mail *
Fall Session 1 October 1,8,15,22,29, November 5 $129+HST
Level I 4:30-5:10 pm (Ages 3+)
Level II 5:15-5.55 pm (Ages 5+)
Level III 6:10-6:50 pm (Ages 7+)
Fall Session 2 November 12,19,26, December 3,10,17 $129+HST
Winter Session 1 January 14,21,28 February 4,11,18 $129+HST
Level I 4:30-5:10 pm (Ages 3-5)
Level II 5:15-5:55 pm (Ages 6-8)
Winter Session 2 February 25 March 3,10,17,24,31 $129+HST
Payment Method:
MasterCard
Visa
EMT to ontario@goldinthenet.com
Credit Card Information:
Name of Cardholder
Card Number
Expiry Date
Waiver/Disclaimer
By registering your child you agree to the following: I agree to have my son/daughter participate in the Gold in the Net Learn to Skate Program.
Waiver: The applicant acknowledges that participation in a hockey program involves certain risks and may result in an injury. Other than the disclosures in the application, the applicant declares to be in proper physical condition and good health to participate in the program. The applicant hereby waives all claims, rights or causes of action against Gold in the Net – Ontario, its officers, directors, employees, coaches or members, for personal injury or loss of property of any nature or kind, however or whenever sustained.
**No refunds after registration payment is received**
The applicant further agrees that Gold in the Net – Ontario may on occasion take photographs at certain events and that these pictures may be used without names to promote Gold in the Net-Ontario.
I have read and agree to the terms of the event waiver/disclaimer *
1 + 0 = ? Please prove that you are human by solving the equation *
