PAYING BY CHEQUE CAMP DIRECTOR qEnclosed please find registration deposit of $ ______DEREK LAXDAL (Minimum of $75.00 per registrant) § Head Coach of the AHL § Head Coach of the RCRC qPost-dated cheque for $ ______WHL 2014 MEMORIAL CUP CHAMPIONS (Balance of my registration fee) § 2013 WHL Eastern Conference Champions (Riverdale Community Recreation Complex) The school will not consider the applicant registered after § 2014 WHL Scott Munroe Regular season st, th June 1 2016 unless a full payment and a signed winners 5 ANNUAL agreement have been received. § 2014 WHL Ed Chenoweth Champions § 2010 Play Finalists! INDEMITY / REFUND § ECHL Coach of the Year 2010 HOCKEY CAMP § 2010 ECHL Regular Season Champions! § Head Coach ECHL (Affiliate The applicant agrees that Riverdale Community Recreation of the Texas Stars AHL & NHL) FEATURING Complex Hockey Camp and its agents will not be held § 2007 ECHL Kelly Cup Champions! responsible for any accident or loss, however caused, and agrees to release its agents from all claims or damages which may arise § Played for & New York DEREK LAXDAL Islanders as a result of or by reason of such accident or loss. The camp HEAD COACH OF THE TEXAS STARS will not be held responsible for any acts of God (floods, § Calder Cup Champion AHL (Springfield lightning, power failures, tornados etc.) which may result in the Indians) 1989-90 CAMP DIRECTOR termination of the school itself during Aug. 1st-5th, 2016. § Drafted by the NHL’s Toronto Maple Leafs 1984 (8th Rd.) The applicant agrees to the following refund policy: Refunds th § LEVEL 4 NCCP (NATIONAL COACHES will be issued up to June 30 , 2016 less a $50 administration fee. CERTIFICATION PROGRAM) In the event of an injury or accident prior to or during the camp, § 25 years Pro experience the appropriate portion of the registration fee will be refunded if § 28 years Hockey School experience the request is accompanied by a doctor’s certificate. No refund will be given if a player leaves by his/her own accord or is § 1986 CANADIAN NATIONAL JR. TEAM expelled by the camp. SILVER MEDALIST § Memorial Cup Champion WHL (Portland ♦ Boys & Girls ♦ 5 to 14 Years Old ♦ ______Winterhawks) 1982-83

Guardian Signature ADVANCED GROUP 10-14 Date ____/____/____ INSTRUCTORS Riverdale Community Recreation

Complex AUG. 1st to Aug. 5th, 2016 • Derek Laxdal • Craig Anderson QUALITY • Troy Hickman INSTRUCTION: • Bruce Helgeson • Tyson Ramsey SKATING, PUCK CONTROL • Riley Lamb (Goalie) OFF ICE TRAINING & CONDITIONING

SKILL DEVELOPMENT

WELCOME HOCKEY PLAYERS SCHOOL INFORMATION SIGN ME UP!

RCRC Hockey Camp Director, Derek Laxdal, would like § Participants will be grouped according to D.O.B. Detach this form/waiver & mail with payment to: to extend an invitation to you to participate in our RCRC § A waiting list will be established for each group! RDCC Hockey Camp Hockey Camp. o Group 1-Boys & Girls 6-9 C/O Don Marriott RCRC Hockey Camp will maintain an excellent o Group 2-Boys & Girls 10-14 PO Box 278 o Advanced 10-14 instructor-to-student ratio. We are committed to offering a Rivers, R0K 1X0 quality program that emphasizes skill enhancement, group § Players may be moved between groups based upon skill level and travel requirements. Please keep a copy of this form! interaction and personal growth, regardless of your age or skill level. RCRC Hockey Camp is committed to offering § Requests for group changes will be considered, but not guaranteed (they need to be submitted in Participant’s Name (Please print): you a very enjoyable and invigorating hockey experience! writing with the participant’s form). The Riverdale Community Recreation Complex Hockey ______Camp is operated in order to support the new sports complex in the town of Rivers, Manitoba. DAY SCHOOLS ♦ AGES 6-14 Circle One: M / F CAMPING IS AVAILABLE AT Date of Birth (DD/MM/YY): _____/_____/_____ LAKE WAHTOPANAH § Five Day Camp-$400 PROVINCIAL PARK § 10% OFF for 2 or more Parent’s Name:

registrants per family! ______ABOUT THE INSTRUCTORS § School jersey included Mailing Address: § 8:00 am drop-off & 4:30 pm pick- Our staff has been selected for their hockey knowledge, Street: ______leadership, and teaching ability, as well as their passion up and dedication to hockey! Our emphasis on life skills § Minimum ten 1 1/4-hour ice Town: ______within a hockey environment will be beneficial to the success of Riverdale Community Recreation Complex sessions (12 1/2 hours for the Prov. ______Postal Code: ______Hockey Camp. Our is to start a tradition where week) students experience success as players, teachers and § Hockey specific conditioning E-mail: ______coaches in their lives.

RCRC Hockey Camp strives to attract quality instructors. (parachutes) Phone # ______-______-______Much of their experience can be attributed to being § Goaltender instruction Work Phone # ______-______-______members of such quality programs. § Off-ice shooting and stick handling

Camp Questions sessions Position (Check one): Skater q Goalie q Contact: § GAME (Friday Afternoon) DEREK LAXDAL Jersey Size (Check one): § [email protected] Excellent supervision Adult Small q Adult Large q [email protected] § Participants are responsible Adult X-Large q Adult XX-Large q

for their own lunches during Provincial Health Care Number: ______

the camp! Medical Concerns: ______

§ Quality instruction from top

______

level instructors

Registration $400 q