2016 SPRING CAMP - PLAYER PROFILE
Name:
E-mail:
Address:
Postal Code:
Telephone:
Cell:
Position:
Shot:
Team:
2015-16 Stats:
Birthdate:
Height:
Weight:
League:
GP
G
A
Pts
PIM
Coach’s Name:
/ GAA
Save %
Coach’s Phone #:
Reference #1
Ph #:
Reference #2
Ph #:
Prov. Health Care# or US Health Insurance:
Parents’ Names:
Parents’ E-mail:
Parents’ Phone:
High School Attended:
Grade:
GPA:
Hockey Goals for 16-17 Season:
As parent of guardian of the above named player, I ________________________________ do hereby consent to said player participating in all
activities of the Nelson Leafs 2016 Spring Camp and do hereby release, absolve, indemnify and save harmless the Nelson Leafs Hockey Club
and the Kootenay International Hockey League, and both organization’s employees, officers, coaching staff, management and/or volunteers,
from any claim(s) which may arise as a result of his/her participation. I assume all risks and hazards incidental to the above article and do
hereby waive all claims whatsoever which I or the above named player may have against the Nelson Leafs Hockey Club and/or the Kootenay
International Hockey League.
Signature
Day
Month
Full Payment ($175 per Player, $200 per Goalie) Must Accompany Player Profile and Medical Form.
Cheques made payable to Nelson Leafs.
Visa or MasterCard Number:
NELSON LEAFS
Expiry Date:
PO Box 311
Nelson, BC
Member of the KJIHL
V1L 5R2
Year