Saratoga, NY (August 4 - 8) Day Camp Registration Form

Player Information

First Name *

Last Name *

Date of Birth *

Player Position *
Forward Defence Goalie

Telephone *

Street Address *

City *

Province / State *

Postal / Zip Code *

Jersey Size *

2008-09 Level Played

2008-09 Team Played

2007-08 Level Played *

2007-08 Team Played *

Parent / Guardian Information

Name *

Email *

Confirm Email Address *

Home Phone *

Work Phone *

Mobile Phone *

How did you hear about us? *

I was referred by?

Are you interested in helping promote our camp?

If Yes - Number of brochures to distribute in my area

Street

Payment Options:
Pay Total: $385.00 USD
Pay Deposit: $150.00 USD

Payment Method *
Online Offline

Additional Items

Item	Price	Quantity
Early Bird (Day Camp) Past Date N/A	$0.00
Early Bird (On-Ice Camp) Past Date N/A	$0.00
Multiple Camps (Day Camp)	$-30.00
Multiple Camps (On-Ice Camp)	$-15.00
Family Discount (Day Camp)	$-70.00
Family Discount (On-Ice Camp)	$-35.00
Goalie Discount (Day Camp)	$-50.00
Goalie Discount (On-Ice Camp)	$-25.00
Friend Referral (Day Camp)	$-20.00
Friend Referral (On-Ice Camp)	$-10.00

Waiver Claim: I acknowledge that hockey is a contact sport and that Scott Drevitch’s Play Like A Pro Camp, its coaches, staff, and agents shall not be made liable to me for any injury or damage incurred while participating in the camp or on the premises at which the camp is held. Furthermore, I submit that any relative, heir, or legal relative from making Scott Drevitch’s Play Like A Pro Camp, its coaches, staff, and agents liable for any injury or damage that may occur during or on the premises of the camp. I also agree that I will not hold Scott Drevitch’s Play Like A Pro Camp, its coaches staff, and agents responsible for any lost or stolen items during the process of the camp or in and about the facilities. In addition to this, I give Scott Drevitch’s Play Like A Pro Camp consent to follow proper emergency procedure with my son/daughter. Scott Drevitch’s Play Like A Pro Camp reserves the right to use any pictures and videos taken during the program for research, instruction, and/ or advertising purposes. I attest that the player is of good health and is able to participate in the physical activities of a rigorous program.

Please check if you agree to the above terms.

(Fields marked with a * are required)