Heads Up Sports Academy
Application Form

I / We understand and appreciate that participation or observation of the sport constitutes a risk to me/us of serious injury, including permanent paralysis or death. I / We voluntarily and knowingly recognize, accept and assume the risk and release Heads Up Sports Academy, the camp directors, and/or instructors, and/or the arena from any and all claims. I / We shall not hold anyone responsible for any accident(s) or observer(s), damage or loss of personal property, however caused, whether on or off the premises.
In signing this application the parent or guardian certifies that the applicant / participant is in good health physically and mentally and is amenable to necessary discipline.
A deposit of $100 is required for all programs and a postdated cheque for the balance owing for June 1st, 2009 to accompany the application.
Please complete application and make all cheques payable to Heads Up Sports Academy (GST # 864271994) and mail to:

Heads Up Sports Academy,
32 Concerto Court,
Ancaster, Ontario
L9G 4V7

Your cashed or cancelled cheque is a confirmation to the school. Please make note of the dates and times as this will be your only reminder.

I / We acknowledge that I have read and understood the terms and conditions of this application and agree to abide by the terms and conditions.


          Parent or Guardians Signature                                          Date

Please Print Clearly:
Player's First Name:
Surname:
Parents' First Names:
Address:
City:
Postal Code:
Phone Number:
Email Address:
Age:
Date of Birth (dd/mm/yyyy):	Day: Month: Year:
Position Played:
Medical Problems

Fall / Winter Programs:
Please select the program you wish to register for:
Houseleague/Select 4 on 4 Shape-Up Program A (at CH/WA SEE BROCHURE)
Houseleague/Select 4 on 4 Shape-Up Program B (at CH/WA SEE BROCHURE)
Houseleague/Select 4 on 4 Shape-Up Program C (at CH/WA SEE BROCHURE)
Adult Fall program - Recreational (at WA)
Adult Fall program - Competitive (at WA)
Womens' Fall Program (at WA)
Fall Risidore & Stepien Power Skating & Hockey Skills Program A
Fall Risidore & Stepien Power Skating & Hockey Skills Program B
Fall Risidore & Stepien Power Skating & Hockey Skills Program C
Fall Risidore & Stepien Power Skating & Hockey Skills Program D
PA Day Hockey Program - Friday September 25, 2009 (at M4)
PA Day Hockey Program - Friday November16, 2009 (at M4)
PA Day Hockey Program - Friday December 4, 2009 (at MF)
PA Day Hockey Program - Friday January 29, 2010 (at M4)
Houseleague / Select Christmas 4 on 4 Challenge - Novice / Atom (at WA)
Houseleague / Select Christmas 4 on 4 Challenge - Peewee / Bantam (at WA)
Christmas Shooting Clinic - Beginner (at WA)
Christmas Shooting Clinic - Junior (at WA)
Christmas Shooting Clinic - High Performance (at WA)
March Break Puck Control Clinic - Beginner (at WA)
March Break Puck Control Clinic - Junior (at WA)
March Break Puck Control Clinic - High Performance (at WA)

Spring / Summer Programs:
Please select the program you wish to register for:
High Performance Pre-Tryout Conditioning Camp (at CH)
Spring - CHIP - Initiation to Hockey (at M4)
Sunday Morning Mixed 3 on 3 Hockey League (at M4)
Saturday Morning Girls' 3 on 3 Hockey League (at M4)
High Performance Robson Technologies 4 on 4 (at M4)
Junior High Performance 4 on 4 (at M4)
Summer Womens' Skills Program (at HD)
Spring Power Skate with Risidore & Stepien Program A (at M4)
Spring Power Skate with Risidore & Stepien Program B (at M4)
Spring Power Skate with Risidore & Stepien Program C (at M4)
Spring Power Skate with Risidore & Stepien Program D (at M4)
Spring Power Skate with Risidore & Stepien Program E (at M4)
Summer Power Skate with Hamilton and Stepien (at M4)
Summer Power Skate with Risidore & Stepien Program A (at M4)
Summer Power Skate with Risidore & Stepien Program B (at M4)
Summer Power Skate with Risidore & Stepien Program C (at M4)
Summer Power Skate with Risidore & Stepien Program D (at M4)
Summer Hockey Skills Camp - July 5th - July 9th 2010 (at M4)
Summer Hockey Skills Camp - July 12th - July 16th 2010 (at M4)
Summer Mike Burgoyne Defenseman Camp (at M4)
Summer Female Conditioning Program (at M4)
Summer Conditioning & Scoring Program (at M4)
Pre Season CHIP Camp (at M4)

Dofasco Programs:
Please select the program you wish to register for:
Dofasco March Break Program - 6-8 yrs (at DF)
Dofasco March Break Program - 9-12 yrs (at DF)
Dofasco March Break Program (at DF)
Dofasco Minor Hockey Skating School (at DF)
Dofasco Pre Season Warm Up (at DF)

Note:
ACC=Ancaster Community Centre
CH=Chedoke Arena
DF=Dofasco Arena
HD=Hamilton Double Rinks
M4=Mohawk 4 Ice Centre
MF=Morgan Firestone Arena
SVA=Spring Valley Arena
WA= Wentworth Arenas

**Note: These camps will be held at various locations, refer to camp details for further information

Select Team Level
AAA AA A BB B C HUB AE
Select House League No Experience
Select Hockey Jersey size or T-Shirt Size If you are attending a full day camp.
YL MS MM ML MXL
Comments / Suggestions:

You may print a copy of your registration by clicking this link:

Print this page

You may also now email your registration to us by clicking this link:

Email this page

Please note that if you are going to email the registration, email one registration per player. It is recommended that you still print out a copy of your registration for your records. To secure a position in the program, HUSA must receive your cheque via mail after submitting your registration.