Registration Form

Please print, fill out, and mail this registration form to the address below.

Skill Level

Last team played for: _________________________

Number of years experience: ______

Position played: __________________

Preferred camp group: __________________

Note: Goalie instruction is available.

Registrant Info

Player's name: ___________________________________

Address: _______________________________________

Phone number: ___________________________________

Email address (only used for future correspondence related to registration, camps or clinics): ________________________

Age: ______ Position: ______________________________

Please list all health conditions (i.e., diabetes, allergies, asthma, heart condition, respiratory condition): __________________

Please list all medications:____________________________

Does the participant require an inhaler or epi-pen? _________

Please list prior injuries: _____________________________

Signature of parent/guardian: _________________________

Privacy Info

Collected in accordance with section 28(2) of the Freedom of Information and Protection Privacy Act, 1989. The information collected is to be used solely for the purpose of the administration of this program. It is understood and agreed that while all diligence is taken to assure the well-being of the participant, there are certain risks that are normal to the sport for which management bears no responsibility. For further information, please call (905)852-4040.

Payment Info

Please mail non-refundable cheque in the amount of:
(please check one of the following)

2009 Summer Camps in Brampton
[  ] Beginners $325
[  ] Experienced Recreational/House League $365
[  ] Elite $465
[  ] Sibling Discount subtract $10
[  ] Hot Meals $10 per day

Weekly Powerskating Sessions in Uxbridge:

House League Level Ages 7-11 Boys/Girls
January 21 - April 1, 2009
[  ] $200 1st child
[  ] $170 2nd child of same family

REP Level Ages 10-13
January 24 - March 28, 2009
[  ] $180 1st child
[  ] $150 2nd child of same family

REP Level Ages 7-10
February 21 - March 28, 2009
[  ] $110 1st child
[  ] $90 2nd child of same family

payable to: Shooting Stars Hockey School

mail to: