2018 Boys Summer Hockey Camp Registration

Player Last Name *

Player First Name *

Birth Date (mm/dd/yyyy) *

Height *

Weight *

Player (cell) *

Level played this year *

Position *

Shoots *

Left

Right

Home Street Address *

City *

State *

Zip Code *

Parent Last Name *

Parent First Name *

Parent (home) *

Parent (cell) *

Parent Email *

Roommate Request *

0/255 characters

I am registering for: (please check all sessions you would like to attend) *

Session 1: July 8 - 14

Session 2: July 15 - 21

Session 3: July 22 - 28

Session 4: July 29 - August 4

*

Boarding: $1,099.00

Day: $925.00

Goalie (Boarding or Day): $699.00

Total Amount Due *

Payment Information

Payment *

Check

Credit card

If you wish to pay with a check, please mail to:

Shattuck-St. Mary's School

Attn: Boys Hockey Camps

P.O. Box 218

Faribault, MN 55021

Credit Card Type

Name on Credit Card

Billing Address for Credit Card

Credit Card Number

Exp. Date (mm/yy)

CVC (3 or 4 digit code)

Please charge the following to my card:

Full amount

$300 deposit

Signature (I authorize SSM to charge my credit card the following amount chosen)

clear

I, as a parent or guardian of the above mentioned child, authorize him to take part in the Shattuck-St. Mary's Boys Elite Hockey Camp. I also authorize any emergency examination, x-ray, medical or surgical treatment deemed necessary by a licensed physician or hospital in Minnesota. I will not hold Shattuck-St. Mary's school, its coaches or staff responsible for accidents or injury that may occur while participating in any on or off-campus activities during his stay.

*

clear

To register, complete this form with a non-refundable deposit of $300 per player. The balance is due on or before June 1, 2018.

For more information, contact:

Christian Bragnalo, Director of Boys Summer Hockey

Phone: 1-507-333-1712

Email: christian.bragnalo@s-sm.org

For registration assistance contact:

Mary Hart, Registration

Phone: 1-507-333-1693

Fax: 507-333-1680

Email: mary.hart@s-sm.org