Third Watch Hockey

Hockey Camp 2012

Online Registration Form

Directions:

1. Fill in the boxes on your         computer.

2. Pay using the link below

3. Click on our logo below to send the form

4. Send us an e-mail that you have registered on line

Name:

Mailing Address:

E-Mail Address:

Date of Birth:

Level (in the fall):

Position:

Contact Parent:

Home Phone:

Work Phone:

Cell Phone:

In Case the parent or guardian cannot be contacted, who can be authorized to contact?

Name:

Relationship:

Phone #:

In case of an accident or serious illness, I request that the camp director contact me. In the event that I cannot be reached, I give my permission to take any action necessary, including an ambulance to transport to the hospital.

Hospital Choice:

________________________________________________________

Signature of Parent or Guardian

________________

Date

Back to Clinic Page

Youth Hockey Organization:

I do hereby forever release Third Watch Hockey from all claims and damages which may result from participation in the Third Watch Camp. I / We also verify that the camper is covered by insurance.  It is further agreed that the Third Watch Hockey is not responsible for lost or stolen personal articles or hockey equipment.

Your signature below confirms acceptance of these terms.

Shirt Size:

X

By Clicking here you can pay online with your credit card using Pay Pal

Click on our logo to

submit Your Registration

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Please Chooseforwarddefenseforward or defensegoal tender

Please Choose OneNo PreferenceEastern Maine Medical CenterSt. Joseph's Hospital

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