Registration form and Camp flyer - Doncaster Hockey Club
Registration form and Camp flyer - Doncaster Hockey Club
Registration form and Camp flyer - Doncaster Hockey Club
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HOLIDAYHOCKEY CAMPWHAT’S THE HOCKEY CAMP ABOUT?<strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> has run its fantasticcamps for ages 7-15 over the last few years.With quality coaches, loads of activities <strong>and</strong>everything supplied these camps are great wayto make new friends, work on your skills <strong>and</strong>learn from the best!The camps are suited to everyone with a rangeof trainings <strong>and</strong> activities to suit all skill levels.TO REGISTER<strong>Registration</strong> <strong>form</strong>s <strong>and</strong> paymentin<strong>form</strong>ation is available athttp://doncasterhockeyclub.com.au/juniors/hockey-programs/hockey-camps/DONCASTER HOLIDAY HOCKEY CAMPCoaches Sam Snow (AHL player),Annie Hansbury (USA CollegeCoach) <strong>and</strong> others TBCDates 1st, 2nd <strong>and</strong> 3rd of July 2013Time 8:30am – 3:30pmIncluded Snacks, Lunch <strong>and</strong> a T-shirtActivities• Water slide• Deflections• The DHC Amazing Race• Guest coaches• On <strong>and</strong> off the field activities <strong>and</strong> 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 <strong>form</strong> for each participant <strong>and</strong> return toSamantha Snow / sam.doncasterhc@hotmail.com / 40 Elmhurst Road, Blackburn 3130SurnameAddressFirst NameSuburbState Postcode Phone (Home)Phone (Mobile)Phone (Work)Email D.O.B / / <strong>Hockey</strong> CentreParent/GuardianEmergency PhoneMedical Conditions/AllergiesMedicare No.Ambulance No.PARENT/ GUARDIAN CONSENTIn allowing my child to participate in the <strong>Hockey</strong> <strong>Camp</strong> 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 <strong>and</strong> in my own right to ABSOLVE AND INDEMNIFY <strong>Doncaster</strong><strong>Hockey</strong> <strong>Club</strong> from any <strong>and</strong> 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 <strong>and</strong> in my own right to RELEASE AND FOREVER DISCHARGE <strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> 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 <strong>and</strong> I INDEMNIFY <strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> for all costs associated therewith.ooI AGREE that <strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> retains the right to utilise images of my participation in the Program for the purposes of promoting<strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> junior development programs.ooI have read, understood, acknowledge <strong>and</strong> AGREE to the above declaration including the warning, release <strong>and</strong> indemnity.<strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> requires the in<strong>form</strong>ation requested in this <strong>form</strong> for use in relation to the Program. Any personal in<strong>form</strong>ation providedwill only be used in accordance with the objects <strong>and</strong> purposes of <strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong>, <strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> general business <strong>and</strong> inrelation to <strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong> junior development programs. If the requested personal in<strong>form</strong>ation is not provided you may not be ableto receive the benefits of registration in the Program. Individuals will be able to access their personal in<strong>form</strong>ation through <strong>Doncaster</strong> <strong>Hockey</strong><strong>Club</strong> 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 <strong>form</strong> 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 Name<strong>Doncaster</strong> <strong>Hockey</strong> <strong>Club</strong>BSB 633108Account Number 142789858Ensure the players last name is included in the payment description.Description should be “G.Smith <strong>Camp</strong>” or for multiple children “Smith.<strong>Camp</strong> X 3” indicating that 3 children from the Smith family have paid.Remember to also send completed registration <strong>form</strong>s (one per child)to Samantha Snow along with receipt of e-transfer.