Briere’s Goalie School – Steve Briere
Mentorship Registration Form
Mentee Information
First Name
Last Name
Date of Birth
Gender
MaleFemalePrefer not to sayOther
Parent / Guardian Information
Parent/Guardian
Relationship to Camper
Primary Phone
Email (for confirmations/updates)
Level of Play (current)
I have read and agree to the Refund & Cancellation Policy.I have read and agree to the Privacy Policy.I have read and agree to the Terms of Service.I have read and agree to the Liability Waiver & Release of Claims
Media & Photo Release
I DOI DO NOT grant permission for Brieres Goalie School to use photographs or video of my child for promotional purposes (website, social media, flyers, etc.), without compensation.
Acknowledgment & Signature
I have read, understand, and agree to all information and policies contained in this registration form.
Parent/Guardian Name (print)
Signature (Type Below)
Date
How did you hear about Brieres Goalie School?
Friend/TeammateCoachSocial MediaWebsiteRink/FlyerEmailOther
