Summer Camp - Application 2015 @FusionHockey fusion.hockey Our Program Sackville Sports Stadium Jun 30th - Aug 13th Tue: 8am - 2pm Thu: 8am - 12pm for detailed schedule visit: fusionhockey.ca 7 Weeks 17.5 hrs - On Ice Development 14 hrs - Dryland Training 4 hrs - Classroom Sessions fusionhockey.ca Fusion Hockey Our Instructors Andrew Wigginton Dal Tigers, SMH VP Development Jeff O’Flaherty Head Coach Valley Wildcats Major Midget, Bantam AA SMH Neil Pashkoski Asst. Coach Cole Harbour Major Midget Wolf Pack Wayne Wigginton Coached all AAA levels in SMH Adrienne Power Canadian Olympian - Sprinter, Dryland Instructor Joe Johnston Dal Tigers Goalie Instructor Apply for your spot today! Once all applications are received we will confirm your spot. Players Name: Birth Year: Parents Name: Address: Division: Level: Position: Phone#: AAA Bantam PeeWee AA Forward Defense $575 $500 Early Bird Cash Discount $450 $450 Refer to Joe Johnston for pricing and details -$100 “Must be enrolled in WTT summer off-ice program. Spots still available.” (due by June 2nd) Adult S M M L L B Goalie $575 $500 Jersey: Youth S Atom A Cash Discount (due by June 16) Email: Midget XL XL Jersey# Choices 1st 2nd 3rd I waive and release Fusion Hockey Instructors and players from any liability for any type of injuries that occur during play. I authorize league staff to use their best judgement in an emergency requiring medical attention. I hereby certify that my child is medically fit to participate in this camp. Parent / Guardian Signature: Payments can be made in person on June 2nd / June 16th Sackville Sports Stadium Conference Room Applications & Money Transfers can also be emailed to [email protected] . $100 Deposit Due by June 2nd. Balance Due before you step on the ice June 30th. Date: Credit Card Payment : (Add 5%) Other Credit Card Type: Name on Card: Card #: Valid from: mm yy Valid to: RESET FORM mm yy PRINT FORM