Holiday & PA Days Booking Form

Parent or Gaurdian Name *

First Name

Last Name

Phone *

Country

(###)

###

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Name of Goaltender *

First Name

Last Name

Which Camp(s) will you be attending? *

PA Day Camp: October 10 - ($275+HST)

Holiday Camp: October 13 - ($275+HST)

PA Day Camp: November 14 - ($275+HST)

PA Day Camp: February 13 - ($275+HST)

Holiday Camp: February 16 - ($275+HST)

Holiday Camp: April 3 - ($275+HST)

Cancellation Policy: *

100% of the cost will be refunded with cancellations made prior to 30 days before the commencement of the camp. Cancellations made within 30 days before the commencement of the camp will require a doctor's note, with 100% of the cost refunded. Payment is otherwise final.

I acknowledge and agree with the cancellation policy above

Media Release *

Please note that by attending our camps, you consent to having your child appear in photographs or videos taken, which may be used for promotional and/or informational purposes, including on social media and our website.

I acknowledge and consent to the Media Release statement above

Waiver of Liability *

I am aware that the participation in Samson Tan’s (“Goalie Engineering”) hockey goaltending training camp has, in addition to the usual dangers and risks inherent in the sport of hockey, certain additional dangers and risks including, but not limited to, the danger and risk of collision with other participants and/or man-made objects (sticks, pucks, boards, ice), and I freely accept and fully assume all such dangers and risks and the possibility of personal injury, death, property damage or loss resulting therefrom. In consideration of the arena and Goalie Engineering permitting my participation in the aforementioned event/program/game I hereby agree as follows: 1. To waive any and all claims that I may have against the Arena, the Sponsors, Samson Tan (“Goalie Engineering”) and their directors, officers, contractors, employees, agents and representatives, and any volunteers in any way associated with the event/program/game, (all of whom are hereinafter collectively referred to as "the releasees"); 2. To release the releasees from any and all liability for any loss, damage, injury or expense that I may suffer or that my next of kin may suffer as a result of my participation in the event/program/game due to any cause whatsoever, including any negligence, breach of contract, breach of statutory duty of care, or breach of the occupiers' liability act on the part of the releases; 3. To hold harmless and indemnify the releasees from any and all liability for any property damage or personal injury to any third party, resulting from my participation in the event/program/game; and 4. That this release of liability shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns in the event of my death. In consideration of my participation in such programs, activities and events, I hereby acknowledge that I am aware of the risks and hazards associated with or related to ice hockey. The risks and hazards of ice hockey include, but are not limited to, injuries from: • Exerting and stretching various muscle groups; • Vigorous physical exertion, rapid movements and quick turns and stops on the ice; • Strenuous cardiovascular workouts; • Collisions with the rink boards, hockey nets and ice; • Being struck by hockey sticks and pucks; • Physical contact with other participants, resulting in injuries to the eyes, teeth, face, head and other parts of the body, bruises, sprains, cuts, scrapes, breaks, dislocations and spinal cord injuries which may render me permanently paralyzed; • Variations in ice surface; • Travel to and from competitive events and associated non-competitive events, which are an integral part of the Organization’s activities. Furthermore, I am aware that: • Injuries sustained in ice hockey can be severe; • I may experience anxiety while challenging myself during the activities; • My risk of injury is reduced if I follow all rules; and • My risk of injury increases as I become fatigued.

I have read and understand this release of liability, and I am aware that by clicking this checkbox for this release of liability, I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators and assigns may have against the releases.