HockeyTech International - Training, Classes, Camps, Equipment - US$ Registration Form

	Summer 2002 Registration Form (US$)...

SUMMER 2002 REGISTRATION

Hystrstd Jystgetss, 1234 Main Street, Mainville, Ontario, Canada X0X 0X0
Tel: 000-000-0000 Fax: 000-000-0000 eMail: pastclient@candoo.com

Select Course and Billeting	Select Quantity	Unit Price	Extended Price
Subtotal (US$):
Sales Tax:
Grand Total (US$):

* Enter Grand Total above into first box of Payment/Waiver section below
Registration Information... ALL FIELDS MUST BE COMPLETED
Player's Name:
Birth Date:
Height:
Weight:	Kilos Pounds
Street:
City:
Province/State:
Postal/Zip Code:
Home Telephone Number:	()
Fax Number:	()
Father's Business Telephone:	()
Mother's Business Telephone:	()
Level:	House League Select A AA AAA C B
Team:
Position:	D F C
Student's Health Insurance Company:

Payment/Waiver

Enter Grand Total here...

Enter cost of Program:
(Grand Total above)

(Person registering completes this box)

Less Discounted
Amount:

(Person registering completes this box)

Amount being
remitted:

(Person registering completes this box)

Check Amount:

(Person registering completes this box)

Post-Dated Check
Amount:

(Person registering completes this box)

Cash:

(Person registering completes this box)

Credit Card Number
(Please Note: VISA only):

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Expiry Date:

Please Read: HTI Policies 2002 PLEASE NOTE: REGISTRATION IS NOT AUTOMATIC ALL APPLICANTS MUST BE FORMALLY ACCEPTED INTO REQUESTED PROGRAMS.
	Cheques should be made payable to “Hystrstd Jystgetss”.
	THERE WILL BE A $25.00 CHARGE FOR “NSF CHEQUES”
	Cancellation refunds will be available until May 1, 2002. However, they will be subject to a $75.00 administration fee. After May 1, 2002, a 50% refund will only be issued for cancellations due to medical reasons to the student...(a doctor's letter is required). A $75.00 administration fee will also be charged for every change made to a previously registered program(s) camp. Registrations received without payment will automatically become void and invalid if proper payment is not received within 14 days.
	Discounts of 10% are available for those enrolling in multiple full day camps. Ask us for details.
	Confirmation letters will be mailed after acceptance into program.
	Players age and skill levels must meet class standards and qualifications.

Policies & Waiver:

1. Student must wear full CAHA approved equipment, including throat guards.
2. All cancellation refunds will be given in the form of a credit for future classes.

The applicant agrees that Hystrstd Jystgetss INC. and/or its proprietors will not be held responsible for any accident or loss however caused, and agrees to release the proprietors from all claims or damage which may arise as a result of such accidents or loss.

In the event of inability to contact me, I hereby give you permission to seek out any necessary medical assistance my child may require while attending the program.

I agree that I shall provide health insurance or other applicable insurance to cover any personal injury and property damage sustained by the student while participating in the activities of or while on the premises of Hockey Tech International Inc.; and that in consideration of the services provided in connection with this ice-skating and hockey program. I/We understand and appreciate that participation in or observation of the sport of Hockey constitutes a risk to me/us of personal injury, including permanent paralysis or death. I hereby release and forever discharge Hockey Tech International Inc. from all demands, causes of action, suits, or liabilities for personal injury and or property damage which I, as a student, or my child as a student, or myself may have as a result of participating in said program. I have read and fully understood the terms of this waiver and release and have executed it voluntarily. I/We authorize the use of any photos taken at a Hockey tech International Inc. camp, by Hockey Tech International Inc. for promotional purposes.

In signing below I affirm that I have read and understand the policies outlined above and throughout this site.

* We require your signature to
confirm agreement with above waiver and to validate the credit card charge.

Signature:

PLEASE PRINT NAME:

After printing, click on your browser's "Back" Button to return to the previous page.

Send Registration and payment to:
Hystrstd Jystgetss, 1234 Main Street,
Mainville, Ontario, Canada X0X 0X0

(Remember to identify yourself AND your Registration!!)

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