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Indicates required field
Student Name
*
First
Last
Phone Number # 1
*
Phone Number # 2
*
Age
*
Parents Names
*
Last Team
*
Jersey Size
*
XL
L
M
S
YXL
YL
Select Camp
*
Atlantic City All Ages
Atlantic City Elite
Atlantic City Super Elite
Atlantic City Super Elite (Invite only)
Tom's River, NJ. All Ages
Tom's River, NJ. Elite
Tom's River, NJ Super Elite
Power Play. PA Elite
Power Play. PA All Ages
Power Play. PA Super Elite
Haverford, Pa All Ages
Haverford, Pa Elite
Haverford, Pa Super Elite
Wake Forest, NC , All Ages
Wake Forest, NC , Elite
Wake Forest, NC , Super Elite
Charleston Ice Palace, All ages
Charleston Ice Palace, Elite
Charleston Ice Palace, Super Elite
Wilmington, NC, All Ages
Position
*
Goalie
Defense
Forward
Medical Allergies
*
Email
*
WAIVER
- I have full knowledge and understanding of the hazards and dangers of Ice Hockey, the serious injury that can happen, and certify that my son/daughter has medical coverage for any "bodily injury" that may occur
Guardian Name *By typing name you agree you have read the above Waiver*
*
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