Newbridge

Academy Senators
Spring Identification Camp 2015

April 27, 28, 29, 2015

6:00-8:00pm
East Hants Sportsplex
Open to all players born in 2001 & 2002
Cost: $150.00
Checking Clinic: April 26th Time: 2:15-8:00PM
East Hants Sportsplex
Cost: $80
*Mandatory for Players born in 2002

Spring ID Camp Registration Form

Players Name

Date of Birth

Street Address

City, Province

Parent Name(s)

Home Phone #

Email

Health Card #

Position

Level 2014/15

Payment

Credit Card #

Gender

rMale rFemale

Postal Code

Cell Phone #

Expiry

rForward rDefence rGoalie

rAAA rAA

rA

rB

rRec

rCash rCheque rCredit Card

Total

Expiry

r$150 (ID Camp Only)

r$80 (Checking Camp Only)
r$230 (Both)

Disclaimer & Refund Policy (Please sign at the bottom)
I hereby give my child permission to be photographed during program activities by Newbridge Academy staff and hereby understand that such photographs become
the property of Newbridge Academy and may be used for the purpose of any promotional purposes deemed necessary and/or relevant. I hereby understand and
agree to Newbridge Academys Refund Policy that any person looking to withdraw from any program offered by Newbridge Academy will receive a full refund (minus
a $50 administration fee) if withdrawing before 14 days prior to the start date or with medical documentation. Any withdraw within 14 days of the start date without
medical documentation is non- refundable. In consideration of the participant, I, the undersigned parent/guardian hereby release and discharge Newbridge Academy
from any and all claims, demands, actions and causes of action which I may have for any damages, loss or injuries suffered by my child or incurred by me and resulting
directly or indirectly from the participation of such child in such program. I hereby undertake to indemnify Newbridge Academy and its servants, agents and
employees and hold them harmless from an in respect of any and all claims, demands, actions and proceedings which may be brought by or on behalf of said child
against Newbridge Academy arising out of his/her participation in the aforesaid program and in respect of any damages, loss or injury incurred by him/her during or
as a result of such participation including all costs and expenses incurred defending any and all claims, demands, actions and proceedings.

Parent Signature

_____________________________________________________

Complete this form and return it to: Newbridge Academy

409 Glendale Drive, Lower Sackville NS B4C 2T6
Fax: 902-252-3108 Email: programs@newbridgeacademy.ca
Call for more information: 902-252-3339