Select EGK Training Program to Register For:—Please choose an option—AURORA WINTER GOALKEEPER TRAINING 2018/19

Email Address

Student First Name

Student Last Name

Date of Birth

Gender—Please choose an option—MaleFemale

Mother's Name

Father's Name

Address

City

Province—Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

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Health Card Number

Please list any medical conditions/concerns:

Terms & Conditions

Cheques Payable to : Extreme Goalkeepers

(Please note a $50.00 charge will apply to all returned cheques and cheques will no longer be accepted as payment.

Cancellation Policy: Requests for refunds must be submitted in writing prior to the first session.

$50.00 administration fee will be applied to all refunds. There will be no refunds once a program commences. In the event that another student fills the spot then a credit note minus the $50.00 administration fee will be provided to be used against the cost of future EGK programs.

Parents must be present at the training ground and not leave their child unattended while at an EGK Session.

General: I authorize Extreme Goalkeepers Inc. permission to take Photos and Videos of son/daughter in training sessions when required. Pictures/videos taken may be used only for promotional purposes and for training logs.

Release/Waiver of Liability for a Minor Child: I the undersigned, individually and as parent or guardian of my son/daughter, a minor, ask that he/she be admitted to participate in Extreme Goalkeepers Inc.'s training. In consideration of such admission, I do hereby agree to release, discharge and hold harmless the directors of Extreme Goalkeepers Inc. and its employees from all causes, liabilities, damages, claims or demands whatsoever on account of any injury or accident involving the said minor arising out the minor's attendance during the program.

Medical Authorization / Release: I hereby authorize the directors and coaches of Extreme Goalkeepers Inc. to provide care and medical treatment as necessary to my son/daughter. In the event that an illness or injury would require more extensive evaluation or treatment, I understand that every reasonable attempt will be made to contact me. However, in the event of an emergency, if I cannot be reached, I hereby give consent for emergency care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.

Privacy Policy: All personal information collected for billing, administration and EGK purposes will not be shared with, or forwarded to, a third party at any time without the permission of the client.

I have reviewed and understood all the above information

Agree to Terms & Conditions