REGISTRATION - Tuesday Shinny 2017 & 2018

Please complete this form and then print it out in landscape format on letter paper. You can then either fax it to us on 416-392-1061 or send it to us at 140 Sherbourne Street, Toronto, M5A 2R6 or even come in and drop it off at our office. Cheques should be made out to Moss Park Arena. Forms will not be registered without payment we do not hold spots.

 All Programs require full hockey equipment

Name

The participant is responsible for his/her own medical coverage. I hereby give permission to have staff arrange for any emergency care including hospitalization if necessary.
I release Moss Park Arena, and/or its agents from all claims or damages which may arise from participation in this activity. Full hockey equipment is required for all programs.

 

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Signature

CANCELLATIONS
No cancellation will be allowed after registration is processed. Exceptions can only be made for medical reasons and must be accompanied by a doctor’s certificate. All cancellations will be subject to a $30 administration fee.

Address
City
Postcode
Email Address
Tel. (Home)
Tel. (Work)
Date of Birth

Gender
Program
Fee
Amount Paid
Payment Method
Visa No.
Expiry Date
Name on Card
Card Holder Signature