Mentorship Subscription - Briere’s Goalie School

Mentorship Registration Form

Mentee Information

First Name

Last Name

Date of Birth

Gender

Male
Female
Prefer not to say
Other

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 DO (optional)

I 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. (optional)

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/Teammate (optional)

Coach (optional)

Social Media (optional)

Website (optional)

Rink/Flyer (optional)

Email (optional)

Other (optional)