How did you hear about Wickenheiser One-On-One?
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As a part of the Wickenheiser One-On-One Tour, the Canadian Association for the Advancement of Women and Sport (CAAWS) invites you to become a part of their Girls@Play program.
Other sports you are interested in (other than hockey) (please select a maximum of two):

Current Involvement
____ Athlete ____ Coach ____ Official ____ Volunteer

____ Please add my name to the CAAWS mailing list.
____ Please add my name onto the CAAWS email list.

Which session would you prefer?
City: _______________________________ Date: _____________________

Session: (time) _____________  ________ (description) _____________________

Jersey size:    Adult       S,         L,          XL  (please circle one)
T-shirt size:   Adult       S,          M,          L,         XL (please circle one)

Signature : ____________________________ Date: ___________________
(parent/guardian if under 18)

Refund Policy — Please note that no refunds will be made unless due to accident or injury occurring after registration and before the clinic. A doctor’s statement will be required verifying the nature of the injury.  

Medical and Waiver Form

Name: (First) ________________________ (Last) ___________________________________       
Provincial Health Card Number:  ________________________________  
Family Physician:  ________________________________________________________    
Physician’s Telephone: ____________________________________________________ 

Significant medical conditions (eg. Epilepsy, diabetes, asthma, dangerous allergies, etc.)
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Head, Back, Joint Injuries (in the past two years)
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Medications taken regularly (excluding vitamins)
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Signature (parent if under 18): _______________________________________________

Participant Waiver    

I have read the complete brochure, application and medical form and agree to the terms therein. I certify that all the questions on the application have been answered correctly and I understand that my child/I will provide their/my own skates, sticks, and equipment (minimum CSA-approved helmet, stick, gloves, and elbow pads although full equipment is highly recommended) and I understand that refunds will not be available unless accompanied by a doctor’s statement verifying the nature of the injury.

I understand that Wickenheiser One-On-One, its associates, proprietors, licensees, sponsors, employees, agents and/or representatives will not be held responsible for accidental injury or death, loss or damage however caused, and hereby agree to release and hold harmless Wickenheiser One-On-One, its proprietors, management, facility owners and operators, employees, agents, sponsors, and/or representatives from all claims, damages, actions, loss, expenses, and demands which may arise as a result of, or by reasons of death, injury loss, damage or medical expense may have been contributed or occasioned by the action, inaction or negligence of Wickenheiser One-On-One, the proprietors, management, facility owners and operators, employees, agents, sponsors, and/or representatives.

If the participant is under 18 years of age at the time of the clinic, I authorize Wickenheiser One-On-One staff to act in the place and position of a parent or guardian of my child while my child is at the Wickenheiser One-On-One clinic. Recognizing this, I authorize each or any of them to provide to my child any medical treatment they consider reasonable and necessary.

Signature ___________________________Date: _________________
(parent’s signature if under 18):