716-860-2528

Goaltending School: OnLine Registration Form

Please fill out this form on your computer. Then send the form electronically by clicking the 'send' button, and mail in your check to the address at the bottom of this page.

Gardner Goaltending — 2011

Name:
Street Address:
Town:
State:
  Zip:
Phone #:
E-mail:
Birthdate:
  Gender:

Height:
Weight:
Health Ins. Co.:
Insurance ID #:
Medical Doctor:
Dr.'s Phone #:
Jersey size (pick 1):
Adult:
# years a Goalie:
Choose a week:
Goalie Camp Week, August 1st - August 5th 2011 ($375 U.S.)     
Future Prospects Week, August 15th - 19th, 2011 ($515 U.S.)
Total Fees:
$   Amount sent in now (U.S. funds): $ (either a $195 deposit or the full week's amount)

Consent & Waiver of Responsibility
Please Read Before Signing

I hereby authorize Greg Gardner, and Gardner Goaltending, and all such staff members, to act for me according to their best judgment in any emergency if I cannot be contacted. I further agree that Greg Gardner and Gardner Goaltending should be held harmless from and indemnified against any and all liability, cost claims, loss or damage which it or they may occur as a result of an accident to my child.

I acknowledge that Greg Gardner has made no representations concerning the operation, supervision, staffing, equipment, or any other aspect of the Camp. I release Greg Gardner of and from all actions, causes of action, suits, damages, judgments, expenses, claims and demands whatsoever in law or in equity, that my child or I or our successors, assigns, heirs or distributees may have against Greg Gardner, for any claim directly or indirectly arising from or out of my child's attendance at the Camp and or Clinics described in this Registration. I understand that any camper who does not abide by the rules and regulations promulgated by the camp is subject to dismissal without reimbursement or recourse.

Gardner Goaltending Institute reserves the right to use any pictures/video taken during the school for advertising and /or instructional purposes. It is further agreed that Gardner Goaltending Institute is not responsible for lost or stolen personal articles or hockey equipment.

Emergency Contact Name:
Comments/ questions:
Phone #:
Signature of Parent/Guardian (Type in your name and the last 4 digits of your credit card (for ID purposes only to act as a 'digital signature'.)
Parent/Guardian Signature:
Date:
 

To pay by Credit Card once you have filled out this page, click the "Send" button below, then click the "Add to Cart" button on that page. To pay by mail, please send a $195 deposit or the total fee to the address below. The balance of the fees must be paid in full 30 days prior to the beginning of the school session or the the spot CAN BE FORFEITED . This application must be signed by a parent or guardian. . Checks should be made payable to "Greg Gardner".

Please mail payment to:
Gardner Goaltending, c/o Greg Gardner,
110 White Cedar Dr.,
East Amherst, NY 14051
 

 

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