Alberta Golden Bears Hockey Skills Camp
December 1617, 2017
(Registration Deadline Nov. 30th, 2017)
Return registrations to the County of Wetaskiwin office in person or by mail (with payment – cash, cheque or debit accepted). Contact the County of Wetaskiwin office or check out our website for program dates and times.
Family Name:
Parent/Guardian First name: / Email address:
Mailing Address: / City: Prov:
Postal Code:
Home phone: / Work/Cell phone:
Emergency contact name: Phone number:
Medical information/Allergies:
PROGRAM INFORMATION (one form per child)
Childs name
(First & Last) / Date of Birth / Age / Gender / AB Health Care # / Program
(Circle Group) / Fee
Novice / Atom
Pee Wee / $75 plus GST
Novice / Atom
Pee Wee / $75 plus GST
Novice / Atom
Pee Wee / $75 plus GST
Novice / Atom
Pee Wee / $75 plus GST
Refund Policy:
A refund of program registration fees will be granted under the following circumstances:
- If the program is cancelled, for whatever reason, by the Leisure & Community Services Department.
- If the participant cancels their registration prior to the registration deadline date of
November 30th, 2017.
- If the participant is unable to attend the program due to extenuating circumstances (i.e. illness, accident, etc.) a doctor’s note may be required,
- Refunds will not be given after the program registration deadline.
Please note: A $10.00 fee will be applied to any registration brought into the County of Wetaskiwin office after the registration deadline of November 30th, 2017.
*County of Wetaskiwin does not take responsibility for administering participant medications (prescription or non-prescription). Participants are required to administer their own medication.
Liability and Personal Information Waiver:
I, ______, hereby release the Municipality or Agency, it’s employees, instructors, agents and volunteers from any claim for loss, injury or damage to person or property either directly or indirectly from the attendance, including participation in any activity scheduled or unscheduled, including travel to and from any location for myself or my children.
I hereby
authorize
do not authorize
the Municipality to use photographs taken of the aforementioned individuals while attending or participating in recreation programs and activities (scheduled or unscheduled) sanctioned by the Municipality. Photographs may be used to promote the Municipality’s programs or used in or as part of the publications, advertisements, newsletters and displays intended for the general public. Parents and media may also have the opportunity to take pictures; any of these photos taken during public events cannot be controlled. No other use of these photographs will be allowed.
**If you do not authorize photographs of the aforementioned individual, it is your responsibility to advise any photographers.**
I acknowledge having read and understood this liability release and accept the terms therein.
Signature of Parent/Guardian: ______Date: ______
Signature of Witness: ______Date: ______
Special Note:
When arriving at the designated drop-off location, your child(ren) will be released to only you, the parent/guardian, or people you have authorized to pick up your child. A child will not be released to anyone else without your prior authorization. If the person picking up your child(ren) is unfamiliar to the Hockey Camp staff, this person will be asked to produce personal identification. To avoid confusion for both your child(ren) and the staff, please inform our staff whenever your child(ren) is to be picked up by someone other than yourself. Please sign below to indicate that you, as the parent/guardian, understand this procedure.
Signature of Parent/Guardian: ______Date: ______
If you have any questions about the Recreation programs, please contact Geoff Lynch, Director of Leisure & Community Services at 780-361-6227 or by email at .
Office Use Only:
Amount received: ______Receipt #: ______Cheque #: ______Date received: ______
The personal information contained on this form is collected under Section 32(c) of the Freedom of Information and Privacy Act and will be used only for the purpose of participating in Leisure & Community Services programs through the County of Wetaskiwin. If you have any questions about the collection and use of this information, please contact the County office at 780-352-3321.