Officials - Sask First Female U16 & U18

Applicant Information

At camp, I would prefer to work as a

First Name *

Last Name *

Birthdate *

Email *

Address *

Town/City *

Postal Code *

Home Phone (000) 000-0000 *

Work Or Cell Phone (000) 000-0000 *

Height (Example: 5 ft 10 in) *

Weight in lbs *

Highest level you have officiated as a REFEREE *

Highest level you have officiated as a LINESPERSON *

T-Shirt Size *

Health Card Number *

Emergency Contact Name *

Emergency Contact Relationship To Official *

Emergency Contact Address *

Emergency Contact Phone Number (000) 000-0000 *

Are You Currently Taking Medication? *

If Yes, Please Provide Type Dosage

Asthma? *

Diabetes? *

Heart Condition? *

Any Known Allergies? *

If Yes, Please List

Hearing Aid? *

Contact Lenses? *

Concussion History *

Surgeries In The Last 5 Years *

Illnesses In The Last 5 Years *

Other Comments

Media Release and Consent Agreement

MEDIA RELEASE AND CONSENT AGREEMENT

I, the parent/guardian, consent for my child to be included in photographs, video, print and/or other similar material and further agree to the use and distribution of the Materials, and any copies, for advertising purposes in any Hockey Saskatchewan publications or other media.

All officials who apply and are certified will be accepted to the camp. Future communication will be sent closer to the clinic date.

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Officials - Sask First Female U16 & U18

Applicant Information

Payment Methods

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PO Box or Suite #

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Your Order Summary

Official Sask First Female Camp Fee

QTY: 1

$65.00

Total

$65.00