2014 Resident Hockey/Adventure Camp

REGISTRATION FORM

TO REGISTER...Please complete the form below.

Select 2014 Camp Location & Dates *

Select 2014 Camp Location & Dates Breckenridge, CO #1 June 22-28 (Sun-Sat) Breckenridge, CO #2 June 29-July 5 (Sun-Sat) Breckenridge, CO BOTH Sessions Jay Peak Resort, VT #1 July 7-13 (Mon-Sun) Jay Peak Resort, VT #2 July 13-19 (Sun-Sat) Jay Peak, VT BOTH Sessions
Select Session *

Select Session BLUE (SQ/PW) ages 9-12 GOLD (Bantam/Midget) ages 13+ Parent Child - Colorado Only Other
Player Name Player Name * First Last
Gender *

Gender Male Female
Player DOB Player DOB * / MM / DD YYYY
Age at camp *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent Name(s) *
Email #1 *
Email #2
Best "Primary" contact number Best "Primary" contact number * - ### - ### ####
HOME Phone HOME Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Number of years of hockey experience *
Player skill level *
Position - I will be attending camp as a: *
I will be attending with a friend, or as part of a group of players (type friends name(s) or Group name below) *

I will be attending with a friend, or as part of a group of players (type friends name(s) or Group name below) Yes No
Name of friend(s) or Group Name
I have attended a Planet Hockey 7 Day Resident Hockey Camp in the past *
How did you hear about this Planet Hockey Camp? *
Family Involvement? *

Family Involvement? Player Only - player will be dropped off and picked up Family Involvement - family members will be at camp.
Airport Shuttle *
Camp Tuition *

Camp Tuition $1,349 - Camp Tuition prior to 2/1/14 $1,399 - Camp Tuition after 2/1/14 $500 Deposit. No discounts apply Other - list at bottom
Discount - if applicable. Discounts can not be combined. *
Jersey Upgrade - I would like to upgrade to the camp SUPER jersey for only $69 (http://www.planethockey.com/page/show/253795-hockey-jerseys). *

Jersey Upgrade - I would like to upgrade to the camp SUPER jersey for only $69 (http://www.planethockey.com/page/show/253795-hockey-jerseys). Yes - $69 (save $30, plus receive free shipping) No
Jersey Upgrade Size - if applicable *
Payment Method *

Payment Method Check - Will send my check immediately Credit Card - I will call Planet Hockey to provide my card number.
Camp Rep - we are looking for enthusiastic parents to help us spread the word and help recruit players. Are you interested? *
Would you like Planet Hockey Director Shawn Killian to contact you with details and information? *
Additional Information
For Office Use Only (please leave blank)
Credit Card #: ______ / ______ / ______ /______ Exp. Date: ________ Billing address: ________ Cardholder Name: __________________________ Camp Tuition: $_______ Discount: $_______ Super Jersey: $_______ Other: $_______ TOTAL DUE $_______ ----------------------------------------------------------- Pmt #1 $_____________ Date____________ TRANS ID # ____________________ Inv #______ Bal Due $__________ PAID IN FULL By:_______ Conf Letter Sent ____________ By: _______ Notes: ____________________________________
For office use only.