Vital Hockey Skills
Hockey development at it's best. Improvement is Vital!
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Step 1 of 5 - Player Profile
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Player Profile
First Name
*
Last Name
*
Date of Birth
*
Position
Forward
Defence
Shoots
Left
right
Current Level
House League
Select
A
AA
AAA
Photo upload
* Optional: We always appreciate having game action shots or still shots of the players in uniform to link to our Vital Alumni Section or player of the month selections.
Parent/Guardian
First Name
*
Last Name
*
Email
*
Mobile Phone
*
Address
*
Street Address
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
In case of emergency who should we contact?
Name
*
Phone Number
*
Relationship
*
Medical Information
Are there any allergies we should be aware of?
Has the player had any major injuries or surgeries?
Does the player carry any of the following?
Epi Pen
Asthma Puffer
Medication
Medic Alert Bracelet
Camp Selection
Which type of camp are you looking for?
Seasonal Skills Camps (Winter, March Break, Aug. Pre-Season)
Summer Hockey Camps (July-Early August)
Select Camp
Winter Break (TBD 2013)
March Break (TBD 2013)
Aug. Pre-Season (Aug 20th -23rd 2012)
Select August Pre-Season Program
9:00am - 11:00am Power Skating & Efficiency
9:00am - 11:00am Power Skating & Efficiency (Group Rate)
11:00am - 1:00pm Explosive Skills & Goal Scoring
11:00am - 1:00pm Explosive Skills & Goal Scoring (Group Rate)
1:00pm - 3:00pm Body Contact Clinic
1:00pm - 3:00pm Body Contact Clinic (Group Rate)
All prices are set for the "Early Bird" Discount. Congradulations, you just saved 20-30 dollars! Be sure to click on appropriate "GROUP RATE" if Registering as part of a Group and enter group name below.
GROUP NAME (if applicable)
Enter the name of the group you are registering under
Select a Week
July 9-12th 2012
July 16-19th 2012
July 23rd- 26th 2012
Aug 13- 16th 2012
Meal plan for the week?
Yes (Add $45)
No
Add a second week?
Yes
No
Select a second week
July 16-19th 2012
July 23rd- 26th 2012
Aug 13-16th 2012
Meal Plan for the second week?
Yes (Add $45)
No
Add a third week?
Yes
No
Select a third week
July 23rd-26th 2012
Aug 13-16th 2012
Meal Plan for the third week?
Yes (Add $45)
No
Add a fourth week?
Yes
No
Select a fourth week
Aug 13-16th 2012
Meal Plan for the fourth week?
Yes (Add $45)
No
Total
$ 0.00 CAD
Minor Waiver/Release RELEASE OF LIABILITY FOR PARTICIPANTS READ BEFORE SIGNING IN CONSIDERATION OF the hockey skill development program being offered, my child/ward, being allowed to participate in any way in the hockey related events and activities, Vital Hockey Skills acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 1) FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child's participation; and, 2) I willingly agree to comply with the program's stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child's readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3) I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Vital Hockey Skills, its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child's involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 4) I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Terms and Conditions
*
Agree
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