OLine.ca :: In The Trenches 2011 Registration

In The Trenches

Registration Form

Please fill out this form as complete as possible. After you have filled in all the required information, Please print this page for your records before clicking on the "Submit Form" button. After you click on the Submit button you will automatically be taken to a page where you will be able to pay for your O-LINE clinic camp with credit card or Paypal. A full payment is REQUIRED to secure your clinic space. If you have any questions, feel free to call us at (514) 708-5757. We look forward to you joining us at our clinic!

Athlete/Coach Information

Select Camp Please select a camp.
Last Name: Your last name is required.
First Name: Your first name is required.
Date Of Birth:
(mm/dd/yyyy) Invalid format (mm/dd/yyyy).
Weight:
Height:
Postion:
Team:

Contact Information

Address:
City:
Province:
Postal Code:
Home Phone: Please enter a vaid phone number (###) ###-#### or leave blank.
Cell phone: Please enter a vaid phone number (###) ###-#### or leave blank.
Email Address: Please enter a valid email address.Your email address is required.
Language:

English
French

Parent/Guardian Information

Parent's Full Name:
Parent's Email Address: Please enter a valid email address.
Parent's Phone Number Please enter a vaid phone number (###) ###-#### or leave blank.
Parent's Cell Phone Number: Please enter a vaid phone number (###) ###-#### or leave blank.

Waiver

I am satisfied that my son/daughter, is in good health to take part in the activities that are part of the Oline.ca Clinic. He/she has my permission to participate in those approved physical activities that make up the Oline.ca Clinic and I absolve LEAD Football Inc. and/or any of its staff, directors, sponsors and any coaches participating on my son/daughter behalf from any and all liability. I further agree with the need to have my son/daughter examined by a physician following any illness or injury as a direct result of this camp, in order to re-establish a bill of good health and that this medical examination is my sole responsibility. LEAD Football Inc. reserves the right to use pictures taken during the clinic for promotional purpose.

PLEASE PRINT OFF THIS WAIVER AND BRING IT TO THE CLINIC. THANK YOU!

I agree to the above waiver
I do not agree to the above waiver