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TWO RIVERS SHOWCASE
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REGISTRATION FORM
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KAMLOOPS STORM CAMP
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TWO CAMPS TO CHOOSE FROM PLEASE MARK WHICH CAMP YOU WISH TO ATTEND
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WEST KELOWNA
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MAY 17 TO 19, 2013
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KAMLOOPS ICE BOX ARENA
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June 7 to 9th, 2013
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Name________________________________
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Birth Date (M-D-Y)_____________________
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Phone: (area code)_____________________
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Citizenship___________________________
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Address______________________________
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City_________________________________
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Province/State_________________________
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Postal/Zip Code_______________________
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Height________________________________
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E-mail_______________________________
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Weight_______________________________
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Shoots___________
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Position#1____________________
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Position#2___________________________
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Team Played for in the 2012-2013____________________________________________________
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Association
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Division
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Level AAA-AA-B
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Coach's name and phone #_____________________________________________________
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Father's Name_________________________________ Mother's Name_______________________
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Care Card-Personal Health No.______________________________________________________
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Injuries and/or Medical Problems the Trainer should be aware of___________________________
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As parent or guardian of the above named player, I (please print)___________________________
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do hereby consent to said player participating in all activities
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and hereby release, absolve, indemnify and save harmless the Storm, BCHL
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Junior Hockey League, or the KIJHL and WHL and the BCHL plus both organizations
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employees, officers coaching staff, management and/or volunteers, from and claim(s) which may
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arise as a result of his/her participation. I assume all risks and hazards incidental to the above
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article and do herby waive all claims whatsoever which I or the above named player may have
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against the member clubs in attendance and/or their Leagues. For the
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insurance purposes, all players must wear equipment (facial protection etc.) equal to what they
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used in the 2012-2013 hockey season.
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Signature of parent or guardian______________________________________ Date_____________
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Method of Payment:
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Cheque Visa MasterCard Money Order Cash Debit
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Credit Card #:
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Exp:
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/
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Make Cheques/Money Orders payable to: Kamloops Storm Hockey
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$200.00 (inc. TAX)
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GOALIES
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$225.00 (inc. TAX)
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BOX 24089 70-700 Tranquille Rd.
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Kamloops, BC V2B 8R3
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Refunds will be available until May 2, 2013 subject to a $25 administration fee
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