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Inscription / Registration Session 2 (Jan. – Mar.) CanPowerSkate

Inscription / Registration Session 2 (Jan. – Mar.) CanPowerSkate. Nom de l’enfant Name of child : _____________________________________________ Adresse / Address : _____________________________________________________________

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Inscription / Registration Session 2 (Jan. – Mar.) CanPowerSkate

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  1. Inscription / Registration Session 2 (Jan. – Mar.) CanPowerSkate Nom de l’enfant Name of child: _____________________________________________ Adresse / Address: _____________________________________________________________ # de tel: _______________________ Date de naissance / Birth date: ____________________ Niveau du joueur(euse): Level of player: ___________________________ Association inscrit avec / Association registered with: __________________________________ Adresse courriel / email address: _____________________________________ Coût du programme : Cost of program : plus frais d’assurance : plus insurance fee: $35.00 $135.00 OFFICE USE Cost of program: _________ Payment: cheque ____ cash ____ Amount paid: Receipt # : ________________

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