Registration - Polar Bears Field Hockey

What would you like to register for?

Program Name*

Summer Training Options*

Fall Training Options*

Fall CUBS Training Options*

Winter Training Options*

Spring Junior Program Options*

Spring Cubs Program Options*

Athlete Information

Gender

Athlete Name*

First Last

Athlete Email*

Date of Birth*

Athlete Home City*

Athlete School/University Name*

Current School Grade/Year*

Are you goalie?*

Shirt Size*

Just for reference

Athlete Medical Information

Describe any Medical Issue that we should be aware of....

Parent/Guardian Information

Parent/Guardian Name 1*

First Last

Parent Guardian Email 1*

Parent/Guardian Phone 1*

Assign a Parent/Guardian 2*

Parent/Guardian Name 2*

First Last

Parent Guardian Email 2*

Parent/Guardian Phone 2

Emergency Information

Who is the Emergency Contact?*

Emergency Name*

First Last

Emergency Phone 1*

Emergency Phone 2

Participant Acknowledgment, Wavier, Release of Liability, Image Rights & Other Polices

Image Rights Waiver

By indicating your acceptance you understand and agree that the Polar Bears Field Hockey staff may take photographic or video images of the above-named registrant. You further grant Polar Bears Field Hockey the right to use such image or likeness in connection with promotion of Polar Bears Field Hockey Academy, tours and the sport of field hockey.

Agreement to Image Rights*

I have read and agree to the Image Rights above

Participant Acknowledgment, Wavier and Release of Liability

Although this program will be operated in a safe and responsible manner, I/we acknowledge and fully understand that each participant in this program will be engaging in activities that involve a degree of risk of injury, or disability. In consideration of my/our child being permitted to participate in this program, I, We, agree for my/our child, myself/ourselves and on behalf of our respective heirs, assigns, personal representatives and next of kin, and assume full responsibility for the risk of injury, or disability, and hereby release and hold harmless Polar Bears Field Hockey, Total Field Hockey Ltd., their respective officers, directors, employees, coaches, agents and volunteers (collectively "PBFH") with respect to any and all injury, disability, or loss or damage to person or property, whether arising from the negligence of PBFH or otherwise, including damages, medical or dental expenses incurred as a result of my/our child's participation in the program. In the event of injury or illness or in the event of a medical emergency, PBFH has our permission to provide or seek appropriate medical care for my/our child.

Agreement to Participant Acknowledgment, Wavier and Release of Liability*

I have read and agree to the Participant Acknowledgment, Wavier and Release of Liability terms above

Anti-Bullying Policy

The Polar Bears Field Hockey (PBFH) is committed to providing a caring, friendly and safe environment for all our members, so they can participate in field hockey in a relaxed and secure atmosphere. Bullying of any kind is unacceptable at our club. Review Policies

Agreement to Anti-Bullying Policy*

I have read and agree to the Polar Bears Field Hockey Anti-Bullying policies.

Billing Information

Enter the details that match your credit card

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Make Payment

Credit Card*

Card Details

Cardholder Name

Payment Received

No

Yes

Manual Payment Notes

Use this field to make a note of the payment method and other transaction information.

Hidden

Date

Discount

$ 0.00 CAD

Early Bird Discount

Subtotal

$ 0.00 CAD

Tax (GST 5%)

$ 0.00 CAD

Total

Other Comments or Message

Order ID

Refund Policy*

Unless stated in a specific tour or program, Polar Bears Field Hockey Refund Policy for any athlete withdrawing after registration is:

- Athletes withdrawing from any element or program has an impact (booked facilities, arranged coaches, travel costs etc.) and therefore we strongly advise parents and athletes to only register to fully participate in our programs.
- Polar Bears Field Hockey registration fees are non-refundable (including injury, conflicts or other reasons)

CAPTCHA

Name

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