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Name(player): *
Surname(player): *
Address : *
City : *
Province : *
Country : *
Postal Code : *
Email address : *
Telephone(home.) : *
Telephone(office.): *
Medical card number : *
Birth date : * Day/Month/Year
Allergies, chronic illness:
Note:
 
* must be filled in
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Category 2007-2008 (Last season)
Beginner Bantam **
Mahg 1 2 Midget **
Pre-Novice Junior **
Novice ** Pro
Atome ** "Old Timers"
Pee-Wee **   
 
** For these categories, please fill in the following section(category played in 2007-2008)
Please Check
Level played in 2007-2008 (last season)
 A   AA   AAA 
 B   BB   Espoir 
 C   CC   Majeur 
Please check
Position
Forward Defence Goaltender
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Accommodations

* Players coming from out of town and need of a place to stay during their hockey camp (summer camp only), please fill in these sections:
Accommodations needed Family pension
Summer camp
Please check
Lodging accommodations offered
Available to accommodate a hockey player (same group)
Available to accommodate a junior major player





Clermont, Labor day Session

I am registering in:
Please check

   Price

1st installment
01/02/2008

2nd installment
01/04/2008
Labor day Session
(August 30, 31 and September 1, 2008)

189,00$

100,00$

89,00$



Thanksgiving session St-Prosper (Beauce)

I am registering in:
Please check

   Price

1st installment
01/02/2008

2nd installment
01/04/2008
Thanksgiving Camp
(October 11, 12 and 13, 2008)

189,00$

100,00$

89,00$



Register soon because places are limited!

For summer session,

priority is given to players registered in 2007 edition

up to February 1st 2008.

After, first ones registered, first ones taken



JRPSS is not responsible for any accidents, injuries mechanical defects, loss or stolen objects. The participants renounce to any claim against the school committee or trainers. The management reserves its rights to cancel or modify the scheduled dates for a major reason.


Name(Parent):
Surname(Parent):

I accept






Send payement to:

Julie Robitaille
C.P. 1283, Shawinigan-Sud, G9P 4E8

Include cheque labeled to:

École de Power Skating Julie Robitaille inc.

for the total payment or partial installments, on dates asked for, must be received no later than
7 days following your electronic registration.