2018 REGISTRATION

Fields marked with a * must be completed.

 

PARENT / GUARDIAN INFORMATION

Are you over 18* : (If so players over 18 do not need to fill out this section)

Yes No

First Name* :

Last Name* :

Mailing Address* :

City* :

Province* :

Postal Code* :

Email:*

Please re-enter your email address:*

Phone* (eg. 123-456-7890) :

Phone - Cell/Work (eg. 123-456-7890) :

PARENTS: Are you able to Volunteer?*

Each family registered for sports is required to complete all 5 volunteer service hours with the BVAA during the year, or your bond cheque will be cashed. Please Choose from the options listed.

Coaching
Fundraising - Catering
Sponsor

Other

Cash my bond cheque

PLAYER TO BE REGISTERED

First Name* :

Last Name* :

Initial

Mailing Address (If different from above):

City (If different from above):

Province (If different from above):

Postal Code (If different from above):

Email: (If different from above)

Please re-enter your email address:

Phone (eg. 123-456-7890) (If different from above):

Phone - Cell/Work (eg. 123-456-7890) :

Date of Birth* :

Year (4 digits, eg. 1990)
Month (2 digits, eg. 01 for January)
Day (2 digits, eg. 19)

Gender* :

Male Female

Division (Please check one):* :

Pick-up Hockey

MONDAY NIGHT - Mixed, Ages 6-11 - Drop-in - $15.00

MONDAY NIGHT - Mixed, Ages 6-11, 20 weeks Monday, Oct 16/2017 to March 26/2018. - $225.00

Skating

KIDSKATE - Fall Session Oct.2/2017 - Dec.18/2017 (Bond Chq $75 / 2.5 volunteer hours) - $150.00

KIDSKATE - Winter Session Jan.8/2018 - Mar.26/2018 (Bond Chq $75 / 2.5 volunteer hours) - $150.00

CANSKATE - Sept.25/2017 - Mar.26/2018 (Bond Chq $125 / 5 volunteer hours) - $250.00

SHOOTING STARS - Sept.25/2017 - Mar.29/2018 (Bond Chq $250 / 10 volunteer hours) - $385.00

JUNIORS - Sept.25/2017 - Mar.29/2018 (Bond Chq $250 / 10 volunteer hours) - $400.00

SENIORS - Sept.25/2017 - Mar.29/2018 (Bond Chq $250 / 10 volunteer hours) - $400.00

PRE POWER SKATING - Fall Session Oct.2/2017 - Dec.18/2017 (Bond Chq $75 / 2.5 volunteer hours) - $150.00

PRE POWER SKATING - Winter Session Jan.8/2018 - Mar.26/2018 (Bond Chq $75 / 2.5 volunteer hours) - $150.00

PRE POWER SKATING - Fall AND Winter Session Oct.2/2017 - Dec.18/2017 AND Jan.8/2018 - Mar.26/2018 (Bond Chq $125 / 5 volunteer hours) - DISCOUNT ONLY UNTIL OCT 10, 2017 - $250.00

POWER SKATING - Fall Session Oct.11/2017 - Dec.13/2017 (Bond Chq $75 / 2.5 volunteer hours) - $160.00

POWER SKATING - Winter Session Jan.10/2018 - Mar.21/2018 (Bond Chq $75 / 2.5 volunteer hours) - $160.00

POWER SKATING - Fall AND Winter Session Oct.11/2017 - Dec.13/2017 AND Jan.10/2018 - Mar.21/2018 (Bond Chq $125 / 5 volunteer hours) - DISCOUNT ONLY UNTIL OCT 10, 2017 - $275.00

Medical Concern:

Special Request:(Sorry, absolutely no guarantees)

REGISTRATION FEES

Name on Credit Card or Cheque that will be used to pay registration fees* :

I will be paying my registration fees by* :

Cheque / Cash Paypal

PLAYER EMERGENCY CONTACT

Contact 1 - Name* :

Phone Number* :

Email:

Contact 2 - Name:

Phone Number:

Email:

Consent for Use of Personal Information
Photo waiver: I hereby give permission to B.V.A.A. to take photographs of my child, children or myself as part of this program. I understand that the photographs may appear in the advertising, on B.V.A.A. website, and or the Facebook page.

I Agree to the Consent for Use of Personal Information statement

Yes    
No

BVAA Hazzard Disclaimer*:
By signing this document you will waive certain legal rights, PLEASE READ CAREFULLY.

Disclaimer: The participant, including his or her parents/guardians, in signing this registration form, chooses to participate in this program at his or her own risk. B.V.A.A accepts no liability for bodily injury, death, property or loss due to any cause whatsoever, including, without limitation, negligence on the part of B.V.A.A its elected officials, employees, volunteers, instructors and agents.

I ACKNOWLEDGE MAKING THIS AGREEMENT
I have read and understood the terms and conditions of this agreement, and by signing it voluntarily, I am agreeing to abide by these terms.

Yes    
No


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