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

Cheques payable to: Hockey Nadeau Leblanc

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 2012-2013
Position	Forward Defense Goaltender
Program
Powerskating, Stickhandling & Shooting sessions	Session 1 Session 2 Session 3		Session 4 Session 5
Select week(s) for 2013 Pierrefonds Summer Skills Camp	July 22 to 26 August 5 to 9 August 12 to 16 August 19 to 23
Select week(s) for 2013 St-Laurent Summer Skills Camp	August 12 to 16		August 19 to 23
Lunch card ($60, 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.