Polar Kings Athletic Club Presents

Polar Kings Athletic Club presents Brodeur Goaltending Camp August 20 - 23, 2017

Age Group&Gender: Atom /PeeWee Bantam /Midget (please circle one) Male or Female

Name: (Last) (First)

Address:

City: Postal Code:

Parent Name(s):

Phone: (Home) (Cell)

Must Include Email:

Birth Date: / / Height: _____ feet inches Weight: _____ lbs dd mm yy

Alberta Health Care Number:

Signatures Required – FORM MUST INCLUDE SIGNATURES

Player - I, ______wish to attend the Polar Kings Athletic Club 2017 Goaltender Camp.

Player’s Signature: ______

Parent/Guardian - I, ______hereby consent to the above named player to attend the Polar Kings Athletic Club 2017 Goaltender Camp.

Parent/Guardian Signature: ______

**Signed Waiver must accompany this form and is required before first skate.** 2017 price is $400.00. This registration will give you priority placement in the main camp Aug 14-19, which is free for goaltenders, however there is a maximum of 4 goalies per division, so if interested please attach a main camp form as well. *Maximum 9 goalies per session, register early!!* Please make cheque payable to: POLAR KINGS ATHLETIC CLUB Mail to: Box 3002 Wainwright, AB T9W 1T1 Or Email to Connie: [email protected] For those registering early, please post date cheques to June 1, 2017.