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USE BOTH FORMS BELOW TO SIGN UP AND TO PAY FOR 2012 TRYOUT CAMP

PAYPAL PAYMENT LINK

 

CAMP INFORMATION FORM **ALL FIELDS MUST BE COMPLETED**

Name:
Address:
Phone:
City:
State:
Zip Code:
Email Address:
Cell Phone:
Birth Date:
Height:
Weight:
Position: F  D  G- Goalie Position is filled
Jersey Size: S  M  L  XL 
Citizenship:

HEALTH INSURANCE INFORMATION

Proof of insurance is required to attend camp.

RESIDENTS OF CANADA: You must have a valid U.S. health insurance carrier in the U.S. for this camp, example: Capital BlueCross, Blue Shield, etc)
Health Insurance Company:
Policy No.:
Hockey Experience:
(i.e. college hockey, junior hockey, stats, role on team, etc.)

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