Queens ID SKATE

Name

First NameLast Name

Birth Year

Current Hockey Team

Skill Level

Player Position

Parent Name

First NameLast Name

Email

example@example.com

Phone Number

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

Does your player have any medical conditions we need to know about? If so please explain.

Next Level Athlete Waiver. IN CONSIDERATION of being allowed to participate in the Activity and other good and valuable consideration, the receipt of which is hereby acknowledged, I the “Legal Guardian” agree on behalf of the “Participant” with Next Level Athlete of Spruce Grove, AB, the “Activity Provider” to the following: DETAILS OF ACTIVITY. 1. The participant will be participating in the following Activity: Next Level Athlete hockey camp (the “Activity”) provided by the Activity Provider. CONSIDERATION 2. Being the lawful guardian of the Participant, and in consideration of the Participant being permitted to participate in the Activity, on behalf of the Participant the Legal Guardian releases and forever discharges the Activity Provider, it’s owners, directors, officers, employees, agents, assigns, legal representatives, and successors from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims, and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participants participation in the Activity, and notwithstanding that such damage, loss or injury may have been cause solely or partly by the negligence of the Activity Provider. 3. The Legal Guardian understands that the Participant would not be permitted to participate in the Activity unless the Legal Guardian signed this Waiver. CONCURRENT RELEASE. 4. The Legal Guardian acknowledges that this Waiver is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant by the Activity Provider, and with the intention of binding the Participants heirs, executors, administrators, legal representatives, and assigns. FITNESS TO PARTICIPATE 5. The Legal Guardian acknowledges to the Activity Provider that the Participant does not have any physical limitations, medical ailments, or physical or mental disabilities that would limit or prevent the Participant from participating in the Activity. If required, the Participant will obtain a medical clearance. PHOTOGRAPH RELEASE. 6. I understand that videos and/or photographs may be taken of the Participants during their participation and used by Next Level Athlete for promotional purposes and I give Next Level Athlete consent to take and use images of the Participant for this purpose. Do you understand?

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Queens ID skate 315pm at the Tri Leisure U11 Girls only

$25.00 CAD Registration Options
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Credit Card Number	Security Code
Expiration Month	Expiration Year

Queens ID SKATE January 2 @315pm

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