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BC Hockey Female Under 16 Zone Selection Camps
Application for the 2018-2019 Season

 
  • Players MUST register for the Zone in which their parents reside. Find Your Zone
  • Registration will not be complete unless online payment has been received.
  • Online payments are processed through PayPal.  With a PayPal account you can pay directly from your bank account. However, a PayPal account is not required when paying with a credit card.
  • IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL WITHIN 24 HOURS, YOU MAY NOT BE REGISTERED. PLEASE CONTACT THE BC HOCKEY OFFICE AT 250-652-2978.

 

Player Information

First Name*
 
Last Name*
 
Date of Birth*  
     
Street Address*
 
City/Town*
If your city/town does not appear in the list, please select the location closest to your home.  
Postal Code*
 
Phone Number*
Phone Number format is 555-555-5555
   
Email*
   
MHA*:
 
Team
Including Division*

 
BC Hockey
District/Zone:*

   
Preferred Position* Secondary Position





 





Shoots*
 
Height* ft. in.    
Weight* lbs.  
 
Does BC Hockey have permission to circulate your contact information, upon request, to interested leagues and teams?*
 
Legal Guardian Information

1. First Name*
 
Last Name*
 
Relationship*
   
Daytime Phone*
 
Email*
   
2. First Name
 
Last Name
Relationship
 
Daytime Phone
 
Email
Medical Information

BC Care Card Number*
 
Family Doctor*
 
Doctor Phone*
Phone number format is 555-555-5555
   
Medical Insurance Number
 
Group Number
 
Certificate Number
 

Hospitalized in the last year?*
 
Presently injured?*
 
Injuries requiring medical attention?*
 
Wears dental appliance?*
 
Ill longer than one week in the past year?*
 
Wears contact lenses?*
 
Allergies to medication, etc?*
 
Asthmatic?*
 
Trouble breathing during exercise?*
 
Diabetic?*
 
Fainting during exercise?*
 
Epileptic?*
 
Difficulty hearing?*
 
Heart Condition?*
 
Interfering health problems?*
 
Learning disability?*
 
Medic alert bracelet?*
 
Wears glasses?*
 
History of concussions?*
 
Taking medications?*
 
Surgery in the past year?*
 
If you selected YES to any of the above medical conditions that may affect your ability to fully participate in the evaluation camp, please specify below.
Emergency Information

Name*
 
Relationship*
 
City/Town*
If your city/town does not appear in the list, please select the location closest to your home.
 
Phone Number*
Format 555-555-5555  
 

By clicking submit you agree to the following:
 
As individual of age of majority / parent / legal guardian (the “Applicant”), I have completed the above information and agree that, provided an attempt has been made to contact the Applicant and the Emergency Contact, I authorize anyone acting on behalf of the British Columbia Amateur Hockey Association to seek medical and / or dental advice or treatment for my son / daughter / self as recommended by a licensed medical practitioner if medical and / or dental treatment is required or suspected to be required as a result of illness, injury or unknown malady. 
 
I further authorize that, at the direction any Program Leader acting on behalf of the British Columbia Amateur Hockey Association, my son / daughter / self may be sent home at my expense in the event of a medical, dental and / or behavioural situation.    
 
Furthermore, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I grant to the British Columbia Amateur Hockey Association (the “Producer”) and to its administrators, successors, assigns, servants, agents, insurers, officers, directors and other successors in interest all rights in and to my / my child’s appearance, name, and / or voice and the results and proceeds thereof in connection with my or my child’s participation in the Producer’s programs and events. 
 
I hereby authorize the Producer to photograph and record on film, tape, or otherwise my / my child’s participation in the Producer’s programs or events (the “Recording”).  I further authorize the Producer to edit the Recording at its discretion; to include the Recording with the performances of others; to add to the Recording sound effects, special effects and music; and  to licence others to use the Recording. 
 
I further authorize the Producer to use my / my child’s name, likeness, voice, biographic information and other information in connection with the Recording. 
 
In addition, I hereby release, remise and forever discharge the Producer, its administrators, successors, assigns, servants, agents, insurers, officers, directors and other successors in interest from any liability in connection with the production and / or use of any Recordings. 
 


Camp Fee: $325.00
GST: $16.25
Total: $341.25
Application Deadline: December 29, 2017
Payment must be received online to be considered registered.
The following refund policy applies to cancellations:
50% refund until 15 days prior to the scheduled camp. NO REFUND within 15 days prior to the start of camp for any reason.




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