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Date of Birth
Year
Month
Day

PLAYER / PARENT / GUARDIAN CONSENT FORM

I am the parent or legal guardian of the named player and confirm that the child is in good general health, is properly equipped, and does not have any unusual medical conditions or impairments. I hereby authorize Julia Gosling Skill Development and/or staff of the City of London and/or anyone acting on their behalf to obtain any necessary medical assistance in the event of an accident or injury sustained by my child. I agree to indemnify and hold harmless Julia Gosling Skill Development, the City of London, their staff, representatives, directors, officers, employees, and volunteers from any and all claims, actions, or demands for damages, loss, or injury that may arise as a result of my child’s participation in any activity or use of any facility operated by the parties mentioned above.

I acknowledge that there is no insurance coverage provided for my child and that it is my responsibility to obtain such coverage if needed. I understand that hockey is a sport that carries the risk of serious physical injury, including but not limited to contact with stationary objects, sticks, pucks, and sharp skates. By checking below, I confirm that I am the parent or legal guardian with the legal authority to accept the above terms and to provide informed consent for the child named above to participate.

This program is held on property owned by the City of London. All participants, parents, and guardians are expected to respect the facilities, grounds, staff, and all facility rules.

Please fill out the players information below. 

SESSION DETAILS

As a reminder they will be participating in:

SKATER GROUP 2 CO-ED
(Birth Year 2013-2016)

$50 
$30* Goalies

Date / Location To Be Announced

PAYMENT DETAILS

 

We ask that you please use Interac e-Transfer to send Julia Gosling the skaters payment which will further confirm their spot!

Email:

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