Clipper Spring Hockey

April 12 - June 20, 2010

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Parental Consent:
I hereby authorize the staff of Clipper Spring Hockey/Briercrest College and Seminary to act for me according to their best judgement in an emergency requiring medical attention, and hereby waive and release Briercrest College and Seminary of any and all liability for injuries or illnesses incurred while in Spring Hockey. I have no knowledge of any physical impairment that would be affected by the participation in the Spring Hockey Program.
*Parent/Guardian First Name:		*Parent/Guardian Last Name:
*Parent/Guardian Phone:	( ) -
*Name on Provincial Health Card:		*Provincial Health Card #:
Additional Medical Insurance:

What medical conditions should we be aware of:


Cost and Payment:
Cost: Atom and PeeWee � 30 hrs = $400 Initiation and Novice � 45hrs = $600 Submit payment to: Briercrest College and Seminary Attn: Terry Dyck 510 College Drive Caronport, Saskatchewan S0H 0S0 Please make cheques payable to Briercrest College and Seminary