Floorball Registration Form

Floorball

Location: Virden Jr High (Subject to change to Mary Mont if VJH is not available)

Dates: Monday/Thursday Evenings- Mon Aug 10, Thurs Aug 13, Mon Aug 17, Thurs Aug 20, Mon Aug 24 (Subject to change)

Time: 6:00pm-8:00pm

Ages: 7-14

Cost: $70

**Game times and locations are subject to change depending on the number of particpants.**

**Participants must have their own floorball stick, goggles/safety glasses and proper footwear.** Virden Sports Store sells them.

Registration Deadline: Aug 8th

Name of Child

First NameLast Name

Age

Please enter the name of the parent or guardian who should be contacted in the case of an emergency.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

In signing this form I release all liability from the organizers, players, and facility (VJH) in case of injury due to participation in any Floorball sports program. I give permission to the organizers to administer any necessary medical attention to my son/daughter in case of injury. I will be notified immediately at above listed numbers if such an occasion occurs. If unable to reach me I give permission to do what is in the best interest of my son/daughter until I am notified. I also understand that my insurance company or I will accept all medical expenses.

Consent

Website:

https://floorballvirden.weebly.com/

Please bookmark this site for recaps, rosters, schedule and more!

Payments can be e-transferred to:

floorballvirden@gmail.com

The cost is $70.00

Any questions or concerns please message:

floorballvirden@gmail.com

Please make payment after submitting your registration form.