Edge Hockey Academy Inc.
41 Nightingale Crescent
Whitby, Ontario L1M 0H4
Camp Location: _______________________________________
Camp Date: _______________________________________
Student Name: _______________________________________
Guardian Name: _______________________________________
Date of Birth: _______________________________________
Address: _______________________________________
Postal Code: _______________________________________
Email Address: _______________________________________
Home Phone #: _______________________________________
Male Guardian Phone #: _______________________________________
Female Guardian Phone #: _______________________________________
Emergency Contact: ___________________________ Phone #: ___________________________
Present Team: ___________________________ Position: ___________________________
Age/Category#: _______________________________________
Health Card #: _______________________________________
Medical Information: _______________________________________
* Payment in full required, H.S.T included in total cost for Canadian Locations.
* Please make cheques payable to Edge Hockey Academy Inc.
* NSF Cheques: An administration cost of $35.00 will apply.
* Please mail registration form with payment to the above address.
* No refund for any camp program. Cancellations for medical reasons will be credited to future camps.
* Conduct - If a student is not behaving appropriately, we reserve the right to send them home.
I, the undersigned, the parent or guardian of my son, daughter or ward, hereby authorize Edge Hockey Academy Inc. or anyone acting on their behalf, to seek and acquire necessary medical aid, care or attention that may be required by the aforesaid minor as a result of any accident or injury that may be sustained by the forenamed child. And I hereby indemnify and save harmless Edge Hockey Academy Inc. from any and all actions, causes of action, claims and demand for damages, loss or injury howsoever arising which hereto after may have been sustained.

In signing below I affirm that I have read and agreed to the policies outlined above.

Parent and or Guardian Signature: ___________________________________

Date: _____________________________