Nadeau Leblanc Hockey - Registration

Are you interested in our programs?
You can register via the internet; please properly fill in the following form.
Once you have sent the form, please forward us a cheque at this address:

ÉCOLE DE HOCKEY
NADEAU / LEBLANC INC.
14700 Pierrefonds Blvd
Suite 100
Pierrefonds, Quebec
H9H 4Y6

The amount of the cheque to be sent is indicated on
the descriptive page of the each program.
In some cases, a second cheque must be delivered as per the date indicated.
Please indicate the name of the child and the program he/she is registered for.
Your place will be guaranteed once your cheque has been received.

You must fill a form for every program you wish to join.
(One registration per submission)

** IMPORTANT: There will be no refund for missed sessions.

Name
Address
City
Postal Code
Allergies
Date of birth
Medicare #
Name of a parent
Phone		Work
Email
Level in 2009-2010
Position	Forward Defense Goaltender
Program
Powerskating, Stickhandling & Shooting sessions	September 2010 November 2010 January 2010		March 2011 May 2011
Select week(s) for Pierrefonds Summer Skills Camp	June 28 to July 2 July 5 to 9 July 12 to 16 July 19 to 23		July 26 to 30 August 2 to 6 August 9 to 13 HC week August 16 to 20
Select week(s) for St-Laurent Summer Skills Camp	August 16 to 20		August 23 to 27
Defensemen Clinics sessions	Aug. 16 to 20, 2010 : 9:00am - 10:30am Atome & Peewee Aug. 16 to 20, 2010 : 10:30am - 12:00pm Bantam & Midget
Lunch card at $50 (for camps)	Yes No
Comments
	*

* By clicking "Submit" you agree to the following Release and Indemnity Form

Each player, parent and/or guardian frees the Nadeau/Leblanc Hockey School Inc. organizers, instructors and/or volunteers of any and all responsibility of accidents, injury or loss suffered by the participant. Therefore, the player, parent and/or guardian agrees to release and discharge any and all claims, actions and proceedings which may be brought against the Nadeau/Leblanc Hockey School Inc. organizers, instructors and/or volunteers for any accidents, injury or loss arising out of the player’s participation.

I hereby authorize the directors or instructors of the Nadeau/Leblanc Hockey School Inc. to make a decision in regards to the emergency care required for my child.