Child Registration & Waiver Form 🏒

Child Registration & Waiver Form 🏒

Please complete this form to register your child for the hockey class and review the waiver details.
Parent / Guardian Information
Parent / Guardian Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Child Information
Child’s Full Name*

First NameLast Name
Child’s Date of Birth*

MonthDayYear
Date
Child’s Age*
YesNo
YesNo
Please list any medical conditions, injuries, allergies, behavioural concerns, or other important information we should know about your child.
Program Information
Program Registering For*
First Session Date*

MonthDayYear
Date
Location*
Pickup and Permissions
Who is authorized to pick up your child?*
YesNo
If yes, please list names of any other authorized pickup people.
Yes, I give permission for my child to appear in photos or videos for Shot Factory promotional useNo, I do not give permission
Waiver and Consent

By submitting this form, I acknowledge and agree to the following:
- I am the parent or legal guardian of the child named above and authorize their participation in the Shot Factory Kids Class.
- I understand and accept the risks associated with participation in hockey and related activities, including potential injury.
- I authorize Shot Factory coaches and staff to obtain emergency medical care for my child if necessary.
- I give consent for coaches and staff to record sessions by photo or video for coaching, training, safety, program review, and promotional purposes, unless I have opted out above.
I confirm that I am the parent or legal guardian.
I have read and agree to the waiver and consent section.
I confirm that the information provided is accurate and complete.
Parent / Guardian Full Name*

First NameLast Name
Signature*

Powered by Jotform SignClear
Date Signed*

MonthDayYear
Date
We currently accept payment through e-transfer and they can be made in full to shotfactorymilton@gmail.com Thank You.

Once Submitted and payment received you will get a confirmation email that your child's spot is reserved and we'll be seeing them April 11th 9:30am
Should be Empty:

Child Registration & Waiver Form 🏒

Parent / Guardian Information

Child Information

Program Information

Pickup and Permissions

We currently accept payment through e-transfer and they can be made in full to shotfactorymilton@gmail.com Thank You.