"*" indicates required fields URLThis field is for validation purposes and should be left unchanged.Player's Name* First Last Player's Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Previous Experience*Name of Person to be Called in an Emergency*Phone*(You will be contacted for details.)Authorized Pickup Person #1:*Authorized Pickup Person #2 (optional):Registration & Payment $225 for 3-Day Session or $90 per Day Walk-OnHow Would You Like to Register?* 3-Day Session ($225) Daily Walk-On ($90 / Day) Select the Days to Participate: April 22 (Monday) April 23 (Tuesday) April 24 (Wednesday) Monday, April 22 Price: Tuesday, April 23 Price: Wednesday, April 24 Price: 3-Day Skills Camp Price: Notes:Total Payment Method*PayPal Checkout American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name AGREEMENT & WAIVERConsent*A medical certificate is required if the applicant suffers from any allergies or if he or she requires medical attention of any kind. I agree that I shall provide health insurance to cover personal injury and property damage sustained while participating in the activities of or while on the premises of the Jack Greig Summer Camp Ice. I acknowledge that ice hockey is a high risk activity and I give approval for my child to participate in all activities of the Jack Greig Summer Camps both on and off ice. I assume all risks and forever absolve, indemnify and hold harmless, the Jack Greig Summer Camps, Jack Greig, and any of its employees in the event of accident or loss however caused. I certify by my signature that the registrant is in good health, and acknowledge that I have read and understand all the conditions contained in this application and agree to abide by them. By checking this box, I certify that I agree to the waiver above. Δ
