Registration form and Camp flyer - Doncaster Hockey Club

HOLIDAYHOCKEY CAMPWHAT’S THE HOCKEY CAMP ABOUT?Doncaster Hockey Club has run its fantasticcamps for ages 7-15 over the last few years.With quality coaches, loads of activities andeverything supplied these camps are great wayto make new friends, work on your skills andlearn from the best!The camps are suited to everyone with a rangeof trainings and activities to suit all skill levels.TO REGISTERRegistration forms and paymentinformation is available athttp://doncasterhockeyclub.com.au/juniors/hockey-programs/hockey-camps/DONCASTER HOLIDAY HOCKEY CAMPCoaches Sam Snow (AHL player),Annie Hansbury (USA CollegeCoach) and others TBCDates 1st, 2nd and 3rd of July 2013Time 8:30am – 3:30pmIncluded Snacks, Lunch and a T-shirtActivities• Water slide• Deflections• The DHC Amazing Race• Guest coaches• On and off the field activities and trainings• Ball machine• Video analysisCost• Early bird (closes 18th June)- $155 for 3 days- $135 for 2 days- $70 for 1 day• Late payment (after 18th June)- $175 for 3 days- $145 for 2 days- $75 for 1 day

DHC DEVELOPMENT CLINIC 2013PARTICIPANT REGISTRATION & PAYMENT FORMComplete one form for each participant and return toSamantha Snow / sam.doncasterhc@hotmail.com / 40 Elmhurst Road, Blackburn 3130SurnameAddressFirst NameSuburbState Postcode Phone (Home)Phone (Mobile)Phone (Work)Email D.O.B / / Hockey CentreParent/GuardianEmergency PhoneMedical Conditions/AllergiesMedicare No.Ambulance No.PARENT/ GUARDIAN CONSENTIn allowing my child to participate in the Hockey Camp program (“the Program”):ooI ACKNOWLEDGE that there are inherent dangers associated with the Program which may result in my child being injured.ooTo the full extent permitted by law, I AGREE both on behalf of the child and in my own right to ABSOLVE AND INDEMNIFY DoncasterHockey Club from any and all liability for injury, loss or damage however caused arising out of my child’s participation in the Program.ooI AGREE both on behalf of my child and in my own right to RELEASE AND FOREVER DISCHARGE Doncaster Hockey Club from allclaims that I or the child may have or may have had but for this release arising from my child’s participation in the Program.ooI AUTHORISE registered Program Coordinators to arrange medical or hospital treatment (including, without limitation, ambulancetransportation) if I am not available to do so and I INDEMNIFY Doncaster Hockey Club for all costs associated therewith.ooI AGREE that Doncaster Hockey Club retains the right to utilise images of my participation in the Program for the purposes of promotingDoncaster Hockey Club junior development programs.ooI have read, understood, acknowledge and AGREE to the above declaration including the warning, release and indemnity.Doncaster Hockey Club requires the information requested in this form for use in relation to the Program. Any personal information providedwill only be used in accordance with the objects and purposes of Doncaster Hockey Club, Doncaster Hockey Club general business and inrelation to Doncaster Hockey Club junior development programs. If the requested personal information is not provided you may not be ableto receive the benefits of registration in the Program. Individuals will be able to access their personal information through Doncaster HockeyClub upon reasonable notice.Name Signed Date / /Please list all player names covered by this payment. Note for payment for multiple players, only one Payment Details form is required.PLAYER NAME DATES ATTENDING NUMBER OF DAYS AMOUNT PER PLAYER1st July 2nd July 3rd JulyTOTAL AMOUNT PAIDPAYMENT METHOD (please tick) ¨ Cash ¨ EFT (Details Below) ¨ Credit Card (at DHC Proshop) ¨ Cheque (Drawers Name)ELECTRONIC FUNDS TRANSFER (EFT)BankBendigo BankAccount NameDoncaster Hockey ClubBSB 633108Account Number 142789858Ensure the players last name is included in the payment description.Description should be “G.Smith Camp” or for multiple children “Smith.Camp X 3” indicating that 3 children from the Smith family have paid.Remember to also send completed registration forms (one per child)to Samantha Snow along with receipt of e-transfer.