Janosz School of Goaltending

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Purchasing:	Buffalo, NY - Leisure Rinks - Winter Break Clinic - 02/16/10 - 02/18/10 On-Ice Time Each Day 10:00 - 11:30am. Full Goalie Equipment Required. Cost $175.00
Player Information
* First Name
* Last Name
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* Date of Birth
Parent/Guardian Information
* Parent/Guardian First Name
* Parent/Guardian Last Name
* Relationship
* E-Mail Address
* Reenter E-Mail Address
* Cell Phone
* Home Phone
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Emergency Contact Information
* Emergency Contact First Name
* Emergency Contact Last Name
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* Waiver	CANCELLATION & REFUND POLICY. ADDITIONAL CANCELLATION & REFUND POLICY FOR JSG FALL / WINTER CLINICS IS DISPLAYED ON CLINIC / DATE SELECTION PAGE All payments are final. No cancellation refunds are granted except for the following conditions: MEDICAL EMERGENCY CANCELLATION - Refund will be granted minus 20% of full registration cost if participant is injured before 1st day of camp that the participant is registered to. Official documentation (i.e. letter head & contact phone #'s) of participants attending physician must be supplied and verification of documentation must be completed before refund will be granted. FAMILY EMERGENCY CANCELLATION - Official documentation (i.e. letter head & contact phone #'s, etc.) plus any other form(s) of documentation must be submitted for verification regarding emergency. Upon completed verification of documentation refund may be granted minus 20% of full registration cost at the discretion of JANOSZ SCHOOL of GOALTENDING. MEDICAL INSURANCE AUTHORIZATION AND LIABILITY RELEASE I acknowledge and fully understand that by checking the "I ACCEPT THE TERMS OF THE WAIVER ABOVE" box that I am the parent or guardian of the said adolesent being registered to a Janosz School of Goaltending 2009 Camp or Clinic and grant permission for my child to attend the Janosz School of Goaltending 2009 Camp or Clinic and to allow him or her to actively participate in all activities. In the event of an injury or illness I grant permission and agree to allow medical treatment if I cannot be contacted. I understand that all medical bills will be my responsibility and not Bob Janosz nor any of the staff affiliated with the Janosz School of Goaltending. I also release Bob Janosz, the Janosz School of Goaltending staff, the host rink, the host rink's staff, and anyone affiliated with the Janosz School of Goaltending from all liability, claims, obligations,and responsibility for any losses, accidents, or injuries of any kind. I also understand that I, the parent or guardian of the said adolesent being registered to a Janosz School of Goaltending 2009 Camp or Clinic, ensure to my full responsibility that the said adolesent being registered to participate in a Janosz School of Goaltending 2009 Camp or Clinic will be equipped with full legal ICE HOCKEY equipment and said ICE HOCKEY equipment will be worn properly at all times while participating in an on-ice session at a Janosz School of Goaltending 2009 Camp or Clinic.
	I accept the terms of the waiver and refund policy above. *