2019 Watford City, ND Goalie Clinic Registration

Parent / Guardian Info

Parent / Guardian Name*

First Last

Parent / Guardian Email*

Enter Email Confirm Email

Phone*

Participant Info

Participant Name*

First Last

Participant Email

Enter Email Confirm Email

Address*

Street Address Address Line 2 City State ZIP Code

Age*

Gender

Male
Female

Birth Date*

Hockey Level for 2019 - 2020 Season*

First time Goalrobber Camp Participant*

Will this be your first time attending a Goalrobber Hockey School?

Yes
No

How did you find out about camp?

Medical and General Infomation Form

The following information is required. All participants must have health insurance and all requested information in order to participate in Goalrobber Hockey Schools and/or any Goalrobber affiliated programs.

Medical Insurance No.*

Address

Street Address Address Line 2 City State ZIP Code

Medical Insurance Group No.

Medical Insurance Family No.

Please list any additional health or treatment info we should have on file.

I.) I/We hereby acknowledge and agree that in consideration of my/our child being permitted to participate in and attendance at Goalrobber affiliated activities.

II.) I Do hereby release the Company, its officers, directors, employees, independent contractors or agents all recourses, claims, causes of action of any kind whatsoever, in respect of all personal injuries including death or property losses which may be suffered as arising out of or connected with the preparation in and attendance at Goalrobber programs and activities, notwithstanding that such injuries or losses may have been caused solely or partly by the negligence of the Company or any of its Offices, directors, employees, independent contractors or agents.

And to hereby agree to indemnify and hold harmless Goalrobber, its officers, directors, employees, Independent contractors or agents from any or all claims, demands, cause of action of any kinds whatsoever including those involving negligence that may be made or initiated by or on behalf of my child arising out of or connected with my child’s preparation for, participation in an attendance at any of the Goalrobber programs or activities.

III.) PHOTO RELEASE I/We grant permission to Goalrobber to use my image(s) (photographs and/or videos) for use in Media publications including: social media, newsletters, general publications, website and/or affiliates, and emails.

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

IV.) REFUND POLICY I hereby acknowledge and understand that all purchases made are final. If I (my goaltender is) am unable to attend camp and have already completed all payments in full, I hereby understand that 50% of the camp fee is non-refundable. The remaining 50% of camp will only be refunded in the form of credit to future Goalrobber activities, goods, or services sold.

Please check this box to show that you have read and agree to our above terms.*

I Agree

Dated*

I have read the complete application and agree to the terms as described therein. I certify that all the questions on the application have been answered correctly. I understand that no refunds will be made for any reason other than the refunds policy provided. This is also my consent, for my child to receive emergency medical assistance by a trained professional in case of accident.

2019 Watford City, ND Goalie Clinic Registration

2019 Watford City Goalie Clinic: June 7th & 8th

Parent / Guardian Info

Participant Info

Medical and General Infomation Form

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