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)

January 28, 2011 PA Day Camp

Winter 2011 Weekly Powerskating

Winter 2011 Weekly Powerskating, Puckhandling, Shooting

April 2011 Pre Try Out Sessions

[  ] Novice ($160+HST) $180.80
[  ] Atom   ($160+HST) $180.80
[  ] PeeWee ($160+HST) $180.80
[  ] Bantam ($160+HST) $180.80

[  ] Novice New Session ($120+HST) $135.60
[  ] Atom New Session   ($120+HST) $135.60

[  ] Goalie Program $240 (HST included)

Uxbridge Summer Camps August 22-26, 2011
[  ] Ages 5-7 Beginner level / House League ½ day ($200+HST) $226.00
[  ] Novice full day ($400+HST) $452.00
[  ] Atom full day ($400+HST) $452.00

[  ] 20% family discount additional child full day camp $372.00

Uxbridge Summer Camps August 29 - September 2, 2011
[  ] Novice full day ($400+HST) $452.00
[  ] Atom full day ($400+HST) $452.00
[  ] PeeWee full day ($400+HST) $452.00
[  ] Bantam full day ($400+HST) $452.00

[  ] 20% family discount additional child full day camp $372.00

For the summer camps, please mail non-refundable deposit cheque in the amount of $100.00 before July 1, 2011 or ASAP. The remainder is due August 1, 2011. First come first serve basis.

payable to: Shooting Stars Hockey School

mail to: