CUMBERLAND GRADS CONDITIONING CAMP
APPLICATION FORM

(To be returned prior to start of camp , 2008 with $150 payment to CUMBERLAND GRADS)

1329 Colonial Road
Navan, Ontario, K4B 1N1
Telephone (613) 835-4297
Fax (613) 835-3283

 

Player’s Name: ________________________________________________________________________________

 

Address: ________________________________________________________________________________

 

City/Town: ______________________________          Postal Code: ________________________

 

Home Tel. No.: (_____) ___________________ Emergency Tel. No.: (_____) _________________

 

Birth Date:     Day: ________ Month: ________ Year: _____ Age as of 2008-08-22: ____________

 

Position: ________                  Height: ______ft ______in                 Weight: ________lbs

 

2007-08 Team: ________________________________________________________________________________

 

Coach’s Name: ___________________________    Tel. No.: (_____) _______________________

 

Family Doctor: __________________________   OHIP Number: ___________________________

 

Address:        _____________________________   Tel. No.: (_____) _______________________

   

                     __________________________________

                     __________________________________

 

Medical History: _____________________________________________________________________________

 

_____________________________________________________________________________

 

 

Do you:      Wear Eye Glasses:     _____ Yes     _____ No

 

                   Take Medication:        _____ Yes     _____ No

                    If yes, specify ____________________________________________________________________

 

                   Needs braces or special taping to compete:     _____ Yes     _____ No

                   If yes, specify _____________________________________________________________________

                   _________________________________________________________________________________

 

 

The above APPLICANT agrees to save harmless the owners and staff of the CUMBERLAND GRADS JUNIOR “A” HOCKEY CLUB and SOO-BOY SPORTS & ENTERTAINMENT INC. from any recourse for damages or loss which may occur and hereby releases the CUMBERLAND GRADS JUNIOR “A” HOCKEY CLUB and SOO-BOY SPORTS & ENTERTAINMENT INC. from any actions which occur while attending this CONDITIONING CAMP. This release covers traveling to and from the ARENA as well as activities on and off the ice.

 

 

Player’s Signature: _________________________________________

Parent/Guardian’s Signature: _________________________________

 

Date Application Returned: ____________________________