2017 Hockey School
25TH ANNUAL BRANDON WHEAT KINGS HOCKEY SCHOOL APPLICATION JULY 24TH - JULY 28TH, 2017 Last Name: _____________________________ First Name: ___________________________________ Address: ____________________________________________________________________________ City: ___________________________________ Province: __________ Postal Code: _______________ Email Address: ________________________________ Parent’s Names: ________________________ Daytime Telephone No.: ___________________ Cell Phone: ___________________________________ Birth Date (M/D/Y) _______________ Age________ Sex:
Male______
Female_______
Position: Goalie ________
Defense
Weight: _______ _______
Have you played hockey with Full Body Contact?
$341.25 ($325.00 plus GST)
Height: ______
Forward ________ Yes / No
Goalies $252.00 ($240.00 plus GST) Please Select Group:
T-shirt Order Application must be received by June 1st to receive a complimentary T-shirt.
□ BANTAM
(Born ‘02, ’03, ‘04)
Please Circle one:
□ PEEWEE
(Born ’05, ’06)
□ ATOMS
(Born ’07 & ‘08)
□ NOVICE
(Born ’09, ‘10) (No Goalies)
Youth: XS
S
M
Adult:
L
XL
M
L
XL
Credit Card: ______________________________________________ Exp:____________________ Name on Card: _____________________________________________________
HOCKEY SCHOOL POLICY In signing this application, the parent certifies that the child is in good, normal health and has no physical handicaps. The SCHOOL will provide every safeguard for the health and welfare of each child, but will not be responsible for sickness or accidents. We reserve the right to use any picture taken during your child’s play at the school for advertising or instructional purposes. The applicant agrees that the Brandon Wheat Kings Hockey School and/or its proprietors will not be held responsible for any accidents or loss, however caused, and agrees to release the proprietors from all claims or damages which may arise as a result of or by reason of such accidents or loss. I have read and agree to the above conditions. ______________________________________________ Signature of Parent/Guardian
_________________________________ Date
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Jersey Cresting Information *Deadline for guaranteed Jersey Cresting is July 3, 2017*
Name to be printed on jersey: ____________________________________ (Please print clearly) Jersey Size: Youth:
L/XL (20" ↔) □
Adult:
S (22" ↔) □
M (25" ↔) □
Jersey Number: 1st Choice: _____________
L (27"↔) □
XL □
2nd Choice: ___________
**Please be very careful when choosing jersey size. Once jerseys are crested, they are final. Dimensions are listed beside each size.
Brandon Wheat Kings #2 1175 18th Street Brandon, MB. R7A7C5 Email: [email protected] Fax: 204.726.3540
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Male______
Female_______
Position: Goalie ________
Defense
Weight: _______ _______
Have you played hockey with Full Body Contact?
$341.25 ($325.00 plus GST)
Height: ______
Forward ________ Yes / No
Goalies $252.00 ($240.00 plus GST) Please Select Group:
T-shirt Order Application must be received by June 1st to receive a complimentary T-shirt.
□ BANTAM
(Born ‘02, ’03, ‘04)
Please Circle one:
□ PEEWEE
(Born ’05, ’06)
□ ATOMS
(Born ’07 & ‘08)
□ NOVICE
(Born ’09, ‘10) (No Goalies)
Youth: XS
S
M
Adult:
L
XL
M
L
XL
Credit Card: ______________________________________________ Exp:____________________ Name on Card: _____________________________________________________
HOCKEY SCHOOL POLICY In signing this application, the parent certifies that the child is in good, normal health and has no physical handicaps. The SCHOOL will provide every safeguard for the health and welfare of each child, but will not be responsible for sickness or accidents. We reserve the right to use any picture taken during your child’s play at the school for advertising or instructional purposes. The applicant agrees that the Brandon Wheat Kings Hockey School and/or its proprietors will not be held responsible for any accidents or loss, however caused, and agrees to release the proprietors from all claims or damages which may arise as a result of or by reason of such accidents or loss. I have read and agree to the above conditions. ______________________________________________ Signature of Parent/Guardian
_________________________________ Date
1
Jersey Cresting Information *Deadline for guaranteed Jersey Cresting is July 3, 2017*
Name to be printed on jersey: ____________________________________ (Please print clearly) Jersey Size: Youth:
L/XL (20" ↔) □
Adult:
S (22" ↔) □
M (25" ↔) □
Jersey Number: 1st Choice: _____________
L (27"↔) □
XL □
2nd Choice: ___________
**Please be very careful when choosing jersey size. Once jerseys are crested, they are final. Dimensions are listed beside each size.
Brandon Wheat Kings #2 1175 18th Street Brandon, MB. R7A7C5 Email: [email protected] Fax: 204.726.3540
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