Leading Edge Hockey: Application Form
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Program |
__________________________________________________ |
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Name |
__________________________ |
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|
Address |
__________________________________________________ |
| City |
__________________________ |
Postal Code |
__________ |
| Phone |
__________________________ |
Age (as of Dec 31/06) |
_______ |
| Email address |
__________________________ |
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T Shirt size
(circle one)
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Youth: L XL Adult: S M L XL XLL |
| Jersey Size
(circle one) |
Youth: L Adult: S M L XL XLL |
| Payment type
(circle one) |
Cheque Money order VISA
Mastercard |
| Signature |
___________________________ |
Date |
_______________ |
| Waiver of responsibility – the applicant, their parents
or guardians, agree that Leading Edge Hockey Development, and it’s instructors
and directors are not liable for, nor will be held responsible for any accident
or loss, however caused, and agrees to release Leading Edge Hockey Development
from any claims and damages. |
| Parent's or Guardian's Signature ____________________________________ |
Leading Edge Hockey Development
Mail to: 555 Nimpkish Street, Comox, BC, Canada, V9M 3E4.
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