Hockey College Registration

 Player  Last Name:     First Name:

 Parent Name:

 Email:  

 Address:       

 City:           Province: Postal Code:

 Phone Number with (area code):  

 Age:   Birthdate (mm/dd/yyyy):      Position Played:

Program Selection and Week of Camp:                    

Selection 1

        

Selection 2 (if applicable)

      

Selection 3 (if applicable)

                                                     

Care Card #

Emergency Contact Name:

Emergency Contact Number:

  Cheques to be mail to: (Please add any medical concerns or personal requests with payment. Thank you.)

                    Len Barrie  2157 Stone Gate, Victoria, B.C. V9B 6R5

**Cancellation Policy - All cancellations will be charged a $50 administration fee - No cancellations will be accepted after July 1st - Medical cancellations will require a doctor's note**

If you have any questions or concerns regarding camps or programs please call Len Barrie (250) 478 - 1053 or email labarrie@shaw.ca

or

For Registration Information contact Jocelyn Beckingham (250) 770 - 8680 or email ajbeck@shaw.ca

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