Registration Form

Please print this page, check the class(es) that you wish to take, complete the personal data section, read & sign the waiver on the reverse panel, and mail this form and a $100 deposit per course to the address listed at the bottom of this page. Please print this page, and follow these steps:

1. Check the class(es) you wish to take.
2. Complete the Personal Data portion.
3. Read & sign the waiver portion.
4. Mail form and $100 deposit per course to the address listed at the end of this page.

CLASSES
MONDAYS
(  )  General Power Skating  7:10pm - 8:25pm
(  )  Introduction to Hockey Skills  8:35pm - 9:50pm
(  )  Intermediate Skills & Strategies  10:00pm - 11:15pm

WEDNESDAYS
(  )  General Power Skating  7:10pm - 8:25pm
(  )  Intermediate Skills & Strategies  8:35pm - 9:50pm
(  )  Advanced Skills & Strategies  10:00pm - 11:15pm

THURSDAYS
(  )  Advanced Power Skating  7:10pm - 8:25pm



PERSONAL DATA
Name: (first) _____________________ (last) ________________________________

Address:  _________________________________________________________________

   (city) _____________________ (province) _______ (postal code) __________

Phone:   (home) (______)____________  (work) (______)____________


Deposit Included:      ______________________________________

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Registration Verified: ______________________________________

Balance Owing:         ______________________________________

Early Registration
Registrations with a $100 deposit received by April 15, 1998 will be guaranteed the early bird Course Fee of $165 plus GST.

Deposits
Registrations MUST be accompanied by a $100 cheque or money order per course.

Balance of Payment
Registrations MUST be accompanied by a $100 cheque or money order per course.

Refund Policy
Deposits are non refundable, unless Breakaway cancels the course. The balance of payment is refundable should Breakaway fill your vacated spot.

Cancellation Policy
Breakaway reserves the right to cancel or alter sessions if enrolment does not meet our minimum requirement.

Alcoholic Beverages
Alcoholic beverages are not allowed on the premises.

Parking
Seneca College collects parking fees until 9pm nightly.

Waiver and Release
I hereby acknowledge that Breakaway Sports Consultants Inc. and its employees are not responsible for any losses, damages or injuries sustained by me in any manner or from any cause whatsoever including and without limiting the generality of the foregoing, gross negligence as a result of my participation in this program and hereby further agree to waive and release all rights I have against Breakaway Sports Consultants Inc.

Signature: ____________________________________ Date: ____________________