High Performance Development Program

June 9 – 11, 2017
July 10 – 14, 2017
August 14 – 18, 2017

Players Name *

Players Name

First Name

Last Name

Date Of Birth *

Date Of Birth

MM

DD

YYYY

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email *

Phone *

Phone

(###)

###

####

Parent/Guardian Name *

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone *

Parent/Guardian Phone

(###)

###

####

Emergency Contact Person *

Emergency Contact Person

First Name

Last Name

Emergency Contact Person Phone *

Emergency Contact Person Phone

(###)

###

####

Position *

Previous Team: 2016-2017 Team (Level) *

Coach’s Name *

Phone

Upcoming Team (Goal): 2017-2018 Team (Level)

Junior Team Affiliation (WHL, Junior A)

Perceived Strengths

Perceived Weaknesses

Goals for Off-Season Training & Development

Strength & Conditioning Experience (Have you worked with a trainer before, if so, who? What type of programming?)

Are you able to commit to a weekend in June? A week in July and August?

Do you have access to a workout facility or equipment? Are you able to commute or move to a place that has the proper facilities? Are you able to buy the required equipment?

Previous Injury History (Have you had a significant injury? Are there parts of your body that cause discomfort?)

Health Concerns

Please print the waiver off and send it to the address below
Download waiver on desktop
Download waiver on mobile

Deadline for application is May 17, 2017 and athletes will be notified by May 25 if they are accepted into the program.

Ochapowace Nation Attention: Harley Garrioch
Box 550
Whitewood, SK S0G 5C0
Fax: (306) 696-2002
Email: harley.garrioch@ochapowace.ca