Shooting/Scoring Registration Form   

Questions can be addressed to me (Ron Johnson) either by email:  ronjohnson07@gmail.com or by phone at 604-838-9345 

Please SUBMIT Payment in full prior to starting sessions: Payment can be made by  cash, check, Interac, Mastercard, Visa or American Express (please note - only ice sessions at GPF will have credit card access at front office, sorry for the inconvenience)

Cost for session is $40 x 15 sessions for a total of $600. Payments must be made in full by 3 payments of $200 with first payment due prior to first ice session ($200 due May 5th) and two post dated checks; $200 dated May 17th and $200 dated June 4th.

To use this form, you can high-light the desired frames with your mouse, copy and paste in WORD and then print. I am hoping to have an online registration to make things easier.  Sorry about the inconvenience.  RON

Mailing address for deposit: PRO-COR FITNESS INC, 10388 Nordel Court, Delta, B.C., V4G-1J7

Hockey Registration Form - 2010 Spring / Summer Training Program Planet Ice Delta
First Name   In.   Last  
Birth Date M______D______YR_____ Age      
Address 1   City   Prov.   Postal __/__/__/ -__/__/__
Address 2   City   Prov.   Postal __/__/__/ -__/__/__
Phone 1   2   Email  
Parent/Guar. 1 First Name   Last  
Parent/Guar. 2 First Name   Last  
Personal Stats Height   Wt   Shot L                      R

Hockey Historical Information -

Division Played 2009-2010               A        PW Level played         A      B       C
Position :                                     FW                                    DEF                                               GT
Comments:

 

I hereby state that I have been cleared medically to participate in this hockey Shooting/Scoring Camp. Signed  
*Doctor's authorization required (only for heart and head injuries) Doctor's Name  
Doctor's Phone 1   Phone 2  

 

The student declares and represents (this portion must be signed prior to participating in any program offered by Pro-Cor Fitness Inc.):

1. The Student is not under any medical disability or under the care of any medical or other practitioner which would prohibit the student from engaging in the activities on ice or in the Training Center

2. The Student is not aware of any physical condition that would endanger the student's health as a result of taking this training program or associated program whatsoever.

3. The Student has received no advice from his or her physician advising against participation in the program offered by Pro-Cor Fitness Inc. or any other similar program whatsoever.

4. The Student is 19 years or older. If under the age of 19, this release form must be signed by parent or guardian.

5. The Student participation in this program is completely voluntary.

6. Based on the representations made by the member and in consideration of permission to participate in this program and/or participate in a fitness program and/or use fitness equipment, and/or their facilities supplied by Pro-Cor Fitness Inc., the student for himself or herself, his or her personal references HEREBY RELEASES AND DISCHARGES Pro-Cor Fitness Inc., their agents, employees, servants or other persons authorized by Pro-Cor Fitness Inc. from all claims that the member or his or her personal representatives might have for any injury or disability, and/or belongings suffered at any time during the course of participation in the on-ice training, off-ice training skill programs, fitness program or while on the premises of the training center for any purposes whatsoever.

7. The student agrees that the conditions in the Agreement shall be the condition of any future participation in or use of Pro-Cor Fitness Inc. program and premises.
I agree with the above *Student if over 19 years of age, Parent or Guardian if otherwise. 

Print Name:

 Sign Name: