2021 Summer Hockey Camp

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Player Name*

Gender*

Male
Female

Date of Birth*

Position*

Fall Team/Club Name*

Fall Team Level Played At*

Age Group Level*

Weeks Attending*

Week 1 - June 7 - 10
Week 2 - June 14 - 17
Week 3 - June 21 - 24
Week 4 - June 28 - July 1
Week 5 - July 5 - 8
Week 6 - July 12 - 15
Week 7 - July 19 - 22
Week 8 - July 26 - 29

Registration Options*

1 Week ($325.00)
Only participating in one (1) week of camp & dry land
2 Weeks ($650.00)
Participating in two (2) weeks of camp and dry land
3 Weeks ($975.00)
Participating in three (3) weeks of camp and dry land
4 Weeks ($1,200.00)
Participating in four (4) weeks of camp and dry land ($300 per week)
5 Weeks ($1,300.00)
Participating in five (5) weeks of camp and dry land ($260 per week)
6 Weeks ($1,440.00)
Participating in six (6) weeks of camp and dry land ($240 per week)
7 Weeks ($1,540.00)
Participating in seven (7) weeks of camp and dry land ($220 per week)
8 Weeks ($1,600.00)
Participating in eight (8) weeks of camp and dry land ($200 per week)

Payment Options

Full Payment ($325.00)
Deposit Payment ($162.50)

Please check the box below as an agreed signature for this waiver. An agreed to waiver by this registrant will be required before they can participate in this NSHDA activity or event.

Please note, By checking off the box, the registrant, parent and/or legal guardian has read and understands this Waiver and Release and agrees to and accepts all the risks and liabilities of this waiver and consent to treat form.

I agree and accept all of the risks and liabilities of this waiver and consent to treat form.*

Running Total

$325.00

CC Convenience Fee $10.40

Registration Fee (is added to all registrations) $0.99

Coupon Code

Total

$336.39

Billing Information

Name*

Payment Method

Credit Card
Offline Payment

Card Number*

Visa
Mastercard
American Express
Discover

Expiration Date*

Country*

Address*

City, State and ZIP Code*

Email*

Phone Number*

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