Future Elite Registration Form

Players who have registered for a camp with us before, do NOT need to complete this form.
Players that have registered before click here

Player Details
Name *:
Postal Address *:
Post Code *:
Home Phone Number *:
Mobile Number *:
DOB *:
Gender *:	Male Female
Email Address *:
Association:
Playing Position
1st Choice:
2nd Choice *:
Travel Arrangements
Arrive to Hawke's Bay via *:	Car Bus Flight
Flight/Bus #:
Departure Date:
Arrival Time:
Depart from Hawke's Bay via:	Car Bus Flight
Flight/ Bus #:
Departure Time and Date:
Apparel
Playing Shirt *:	9-10yr(28 Inches) 11-12yr(30 Inches) 13-14yr(32 Inches) XXS(34 Inches) XS(36 Inches) S(38 Inches) M(40 Inches) L(42 Inches) XL(44 Inches)
Medical History
Medical History/Injury(Relevant to the Coach):
Parent/Guardian Details
Parent Name *:
Home Phone *:
Work Phone *:
Mobile:
Email *:
Payment Information
Payment Options *:	$680(payment by 07/04/08) Cheque Direct Deposit
Cheque: Must be made out to "Kelt Capital Hockey Academy"
Direct Deposit(Please arrange with you bank): Acc Name: Kelt Capital Hockey Academy Acc #: 010685-0151361-00 Ref Details: Initial & Surname/FE (Future Elite) e.g. LThomson/FE
Declaration
1.The details I have provided are true and correct. If they change I will notify Kelt Capital Hockey Academy, in writing, as soon as possible.
2.I understand that there are inherent risks of danger and injury in hockey. I agree that The Kelt Capital Hockey Academy are absolved from all liability arising from injury or damage arising of my participation in any activity.
3.I release, discharge and indemnify the Kelt Capital Hockey Academy from all proceedings, claims, demands, losses, damages, penalties, costs and expenses arising from in connection with my participation in hockey.
4.If I play or umpire hockey, i believe i am medically and physically fit and able to participate. If i am injured or ill, it is my responsibility to inform my coach and my team and take such steps as a medical practitioner recommends.
5.I am entitled to have access to and correct my personal information
6.I agreed to being photographed, filmed, videoed or have images recorded and the KCHA may use such images in connection with the promotion of hockey. I am entitled to request access to such images and to take copies of them at my cost.
7.I agree that the personal details on this form will be collected in accordance with the Privacy Act 1993 for the purpose of: a)processing this application and administration of the database including disclosure of information on the database. b)enabling the organisation to carry out their various functions under their respective constitutions, regulations and policies; complying with the law; communicating with me and providing Information relating to my role in hockey and enabling authorised sponsors to provide me with promotional and marketing material unless the box below is ticked
Promotional Gear
Would you like to recieve promo gear?:	(select if you wish to recieve)
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