Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Child's Name*

Child's Age Group*

Days participant will be attending*

Tues

Wed

Thurs

Fri

Estimated Hockey experience*

General or normal activity level*

Does your child have any medical conditions that require medication or may effect their participation in all facets of the program?*

Yes

No

If YES, please provide more information or medication required whilst at the camp Max. 255 characters

Does your child have any allergies?*

Yes

No

If Yes to above, please list Max. 255 characters

Does your child have their own stick & shin-pads?*

Yes

No

Emergency Contact - Name*

Emergency Contact - Phone*

Do you consent to your child being photographed or videoed with the possibility of images being used in reporting & promotional material.*

Please note