High Performance Skills Academy
Ecole Charleswood School
High Performance Skills Academy Program Goals: Promote active and healthy living through hockey within Ecole Charleswood School Improve skill development for all high-performance female and male student-athletes Program Features: Highly qualified and Hockey Manitoba certified instructors Focus on individual skill development and tactics through high repetition drills, stations, and small-area games Before school programming Program Director and Head Instructor: Trevor Hildebrand has coached for the past six (6) years with four of those years as a coach with the Shaftesbury Titans Prep (Canadian Prep/Sport School). The teams he has worked with have achieved a vast amount of team and individual success. As head coach of the St. Vital Victorias, his team won a league championship and the Titans Prep, where Trevor is now the head coach, have won numerous tournament championships at prestigious events. In addition, he has worked with many female players that have graduated and gone on to play and contribute at the CIS and NCAA level. Trevor brings a high level of energy to the rink and tries to instill a strong and focused work ethic in his players. His positive, fun, and motivational approach will enable players to be challenged and will push them to excel and improve upon their individual skillset. Program Details: Eligibility: Program Dates: Venue:
Student-Athletes in grades 5 – 9 October, 2016 - February, 2017 Eric Coy Arena (535 Oakdale Drive)
Please check whether you would be interested in one (1) or two (2) sessions per week: □ One (1) Session Per Week (20 Sessions): Cost (Skaters): $525 Cost (Goalies): $250 □ Two (2) Sessions Per Week (36 Sessions): Cost (Skaters): $975 Cost (Goalies): $450 *Payment schedule will be provided once registration has closed
Registration Information: Please fill out the registration form (listed on back) and remit a $250 non-refundable deposit (credited against fees) to: Futures Hockey 74 Brabant Cove Winnipeg, MB R2N 4R2 PLEASE REGISTER EARLY AS SESSION(S) WILL BE LIMITED TO 24 SKATERS AND 2 GOALIES For further information please contact Trevor Hildebrand at [email protected]
Ecole Charleswood School
High Performance Skills Academy REGISTRATION FORM Last Name:
_______________________
First Name:
Birthdate:
_______________________
Gender (circle):
School Attending: _____________________
_____________________________ Male
2016 - 17 Grade (circle):
5
Female 6
7
8
9
Home Address: _____________________________________________________________________ Parent/Guardian Name(s): Email:
______________________
________________________
2015 - 16 Level of Hockey: AA
A1
A2
Phone:
_____________________________ ______________________________
A3 Position(s) (circle all that apply):
F
D
G
Manitoba Health Number:
________________________________________________________
Known Medical Conditions:
____________ Allergies: ____________
Asthma: _________
PLAYERS ARE RESPONSIBLE FOR THEIR OWN EQUIPMENT, STICKS, TAPE, WATER BOTTLE, ETC.
Medical/Liability Waiver Form We, the parents/guardians of _______________ (child’s name) in consideration of your acceptance of my child as a participant in the High Performance Skills Academy (the “Program”), hereby waive all claims against Futures Hockey, its instructors, and managers, or anyone else working on behalf of the program and release such persons from all claims for injuries sustained by my child incidental to, connected with, or arising out of the program activities for which my child is enrolled, including injuries sustained as the result of negligence of the program’s instructors but not including injuries sustained as a result of their willful or intentional misconduct or gross negligence. I do hereby waive the program, its sponsors, instructors, coaches, supervisors, participants, and persons transporting my child to and from activities, from and against any claim arising out of injury or harm incidental to, connected with, or arising out of program activities. I understand that hockey is a potentially dangerous activity and that the program does not have any medical insurance covering my child and that the program and its representatives shall have the discretion to use whatever means they deem necessary to treat and transport my child in an emergency, which I shall be responsible for the cost, and that I shall waive all claims except for claims arising from willful or intentional misconduct or gross negligence. The authority hereby given shall remain in effect unless it is withdrawn in writing.
Parent/Guardian:
_____________________
Date:
___________________, 2016
Parent/Guardian:
_____________________
Date:
___________________, 2016
High Performance Skills Academy Program Goals: Promote active and healthy living through hockey within Ecole Charleswood School Improve skill development for all high-performance female and male student-athletes Program Features: Highly qualified and Hockey Manitoba certified instructors Focus on individual skill development and tactics through high repetition drills, stations, and small-area games Before school programming Program Director and Head Instructor: Trevor Hildebrand has coached for the past six (6) years with four of those years as a coach with the Shaftesbury Titans Prep (Canadian Prep/Sport School). The teams he has worked with have achieved a vast amount of team and individual success. As head coach of the St. Vital Victorias, his team won a league championship and the Titans Prep, where Trevor is now the head coach, have won numerous tournament championships at prestigious events. In addition, he has worked with many female players that have graduated and gone on to play and contribute at the CIS and NCAA level. Trevor brings a high level of energy to the rink and tries to instill a strong and focused work ethic in his players. His positive, fun, and motivational approach will enable players to be challenged and will push them to excel and improve upon their individual skillset. Program Details: Eligibility: Program Dates: Venue:
Student-Athletes in grades 5 – 9 October, 2016 - February, 2017 Eric Coy Arena (535 Oakdale Drive)
Please check whether you would be interested in one (1) or two (2) sessions per week: □ One (1) Session Per Week (20 Sessions): Cost (Skaters): $525 Cost (Goalies): $250 □ Two (2) Sessions Per Week (36 Sessions): Cost (Skaters): $975 Cost (Goalies): $450 *Payment schedule will be provided once registration has closed
Registration Information: Please fill out the registration form (listed on back) and remit a $250 non-refundable deposit (credited against fees) to: Futures Hockey 74 Brabant Cove Winnipeg, MB R2N 4R2 PLEASE REGISTER EARLY AS SESSION(S) WILL BE LIMITED TO 24 SKATERS AND 2 GOALIES For further information please contact Trevor Hildebrand at [email protected]
Ecole Charleswood School
High Performance Skills Academy REGISTRATION FORM Last Name:
_______________________
First Name:
Birthdate:
_______________________
Gender (circle):
School Attending: _____________________
_____________________________ Male
2016 - 17 Grade (circle):
5
Female 6
7
8
9
Home Address: _____________________________________________________________________ Parent/Guardian Name(s): Email:
______________________
________________________
2015 - 16 Level of Hockey: AA
A1
A2
Phone:
_____________________________ ______________________________
A3 Position(s) (circle all that apply):
F
D
G
Manitoba Health Number:
________________________________________________________
Known Medical Conditions:
____________ Allergies: ____________
Asthma: _________
PLAYERS ARE RESPONSIBLE FOR THEIR OWN EQUIPMENT, STICKS, TAPE, WATER BOTTLE, ETC.
Medical/Liability Waiver Form We, the parents/guardians of _______________ (child’s name) in consideration of your acceptance of my child as a participant in the High Performance Skills Academy (the “Program”), hereby waive all claims against Futures Hockey, its instructors, and managers, or anyone else working on behalf of the program and release such persons from all claims for injuries sustained by my child incidental to, connected with, or arising out of the program activities for which my child is enrolled, including injuries sustained as the result of negligence of the program’s instructors but not including injuries sustained as a result of their willful or intentional misconduct or gross negligence. I do hereby waive the program, its sponsors, instructors, coaches, supervisors, participants, and persons transporting my child to and from activities, from and against any claim arising out of injury or harm incidental to, connected with, or arising out of program activities. I understand that hockey is a potentially dangerous activity and that the program does not have any medical insurance covering my child and that the program and its representatives shall have the discretion to use whatever means they deem necessary to treat and transport my child in an emergency, which I shall be responsible for the cost, and that I shall waive all claims except for claims arising from willful or intentional misconduct or gross negligence. The authority hereby given shall remain in effect unless it is withdrawn in writing.
Parent/Guardian:
_____________________
Date:
___________________, 2016
Parent/Guardian:
_____________________
Date:
___________________, 2016
