Ascend Hockey Camp Registration

1
Player name
First Name
Last Name
2
Goalie?
YESNO
3
Date of Birth
Date
Year
Month
Day
4
Age
5
Position and Level of PlayWhat was the last/preferred position and level of play your child was at.
Ex. Forward U10 AAA or Defense U10 tier 1
6
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
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Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
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Guinea-Bissau
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Hungary
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India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
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Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Emergency Contact Name
8
Emergency Contact Phone
Area Code
Phone Number
9
Parent Name
First Name
Last Name
10
Parent Phone
Area Code
Phone Number
11
Camp Registration* This field is required.Choose your camp registration. You can add more than one camp.
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My Camps
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ORDER SUMMARY
Total costUSD
Hampton Roads Iceplex PRO SKATING AND SKILLS CAMP June 3-4
$295.00Edit
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Quantity
Wake Forest PRO SKATING AND SKILLS CAMP ( Beginner-Intermediate) June 6-8
$325.00Edit
Back
Quantity
Wake Forest PRO SKATING AND SKILLS CAMP ( Elite Challenge Group)June 6-8
$325.00Edit
Back
Quantity
Chilled Ponds PRO GOAL SCORING CAMP (Beginner-Advanced)June 10-11
$325.00Edit
Back
Quantity
Skate Frederick PRO SKILLS AND 3 vs 3 DEVELOPMENT CAMPJune 19-22
$525.00Edit
Back
Quantity
Skate Frederick PRO SKILLS AND 3 vs 3 DEVELOPMENT CAMP June 19-22 GOALIE FEE
$250.00Edit
Back
Quantity
The Rinks at Shelton PRO SKATING AND SKILLS CAMP(HOUSE/SELECT) June 24-25
$325.00Edit
Back
Quantity
The Rinks at Shelton PRO SKATING AND SKILLS CAMP(ELITE CHALLENGE GROUP A-AAA) June 24-25
$325.00Edit
Back
Quantity
Holiday Twin Rink PRO GOAL SCORING CAMP (Beginner-Advanced) JUNE 26-28
$325.00Edit
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Quantity
Holiday Twin Rink PRO GOAL SCORING CAMP (Beginner-Advanced) *OPTIONJUNE 26-28
$375.00Edit
Back
Quantity
Terwilligar CANADA DAY FACEOFF ( AGES 4-6)JULY 1-3 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Terwilligar CANADA DAY FACEOFF ( AGES 7-9)JULY 1-3 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Terwilligar CANADA DAY FACEOFF ( AGES 10-12)JULY 1-3 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Terwilligar CANADA DAY FACEOFF ( AGES 13-15)JULY 1-3 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Flames community arenas CANADA DAY FACEOFF ( AGES 4-6)JULY 5-7 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Flames community arenas CANADA DAY FACEOFF ( AGES 7-9)JULY 5-7 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Flames community arenas CANADA DAY FACEOFF ( AGES 10-12)JULY 5-7 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Flames community arenas CANADA DAY FACEOFF ( AGES 13-15)JULY 5-7 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Servus place ELITE CANADA DAY FACEOFF ( AGES 7-9)JULY 9-11 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Servus place ELITE CANADA DAY FACEOFF ( AGES 10-12)JULY 9-11 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Servus place ELITE CANADA DAY FACEOFF ( AGES 13-15)JULY 9-11 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
7 chiefs sportsplex ELITE CANADA DAY FACEOFF ( AGES 7-9)JULY 13-15 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
7 chiefs sportsplex ELITE CANADA DAY FACEOFF ( AGES 10-12)JULY 13-15 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
7 chiefs sportsplex ELITE CANADA DAY FACEOFF ( AGES 13-15)JULY 13-15 ( PRICES IN CAD) GOALIES IGNORE INVOICE
$395.00Edit
Back
Quantity
Skate Nation PRO SKATING AND SKILLS CAMPJuly 17-19
$325.00Edit
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Skate Nation PRO SKATING AND SKILLS CAMP *OPTIONJuly 17-19
$375.00Edit
Back
Klick Lewis PRO SKATING AND GOAL SCORING CAMP ( HOUSE/ SELECT)July 20-21
$325.00Edit
Back
Klick Lewis PRO SKATING AND GOAL SCORING CAMP ( ELITE CHALLENGE A-AAA)July 20-21
$325.00Edit
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Mt. Lebanon PRO GOAL SCORING CAMP ( HOUSE/SELECT)July 22-23
$325.00Edit
Back
Mt. Lebanon PRO GOAL SCORING CAMP ( ELITE CHALLENGE A-AAA) 2July 22-23
$325.00Edit
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Holiday Twin Rinks 3 VS 3 DEVELOPMENT CAMPJuly 24-26
$325.00Edit
Back
Mohawk 4 Ice CentreJuly 27-28
$325.00Edit
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Holiday Twin Rinks 3 VS 3 DEVELOPMENT CAMP *OPTION 2July 24-26
$375.00Edit
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Bill Gray's Regional IcePlex PRO GOAL SCORING CAMP(HOUSE/SELECT) August 3-4
$325.00Edit
Back
Quantity
Bill Gray's Regional IcePlex PRO GOAL SCORING CAMP ( ELITE CHALLENGE A-AAA) August 3-4
$325.00Edit
Back
Quantity
The Rinks at Shelton PRO GOAL SCORING CAMP(HOUSE/SELECT) August 5-6
$325.00Edit
Back
Quantity
The Rinks at Shelton PRO GOAL SCORING CAMP ( ELITE CHALLENGE A-AAA Players) August 5-6
$325.00Edit
Back
Quantity
Riz 3 vs 3 Development CampAugust 10-11
$325.00Edit
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Riz 3 vs 3 Development Camp OPTIONAugust 10-11
$375.00Edit
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Montclair State Ice Arena PRO GOAL SCORING CAMPAugust 12-13
$335.00Edit
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Warrior PRO GOAL SCORING and 3 vs 3 Development CampAugust 18-20
$375.00Edit
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3 vs 3 Development Camp Hampton Roads Ice PlexAugust 22-24
$295.00Edit
Back
WEM HOLIDAY SKILLS 3 VS 3 DEVELOPMENT CAMPTBD! PRICE IS IN CANADIAN DOLLAR -----ALL PAYMENTS AND DEPOSITS TO BE MADE VIA E-TRANSFER - Pblamoureux@gmail.com All registered players must pay a non-refundable $100 deposit to hold their spot in camp
$350.00Edit
Back
Total cost $0.00
12
Canada day and Christmas camps only**Please review sizes below and answer which size your child needs on the next section.
13
Canada day and Christmas camps only**Please enter what size your child needs.
14
Parent Email
example@example.com
15
Newsletter
Yes, subscribe me to Ascend Hockey emails.
16
Insurance Provider
17
Policy Number
18
Group Number
19
Policy Holder Name
20
AllergiesPlease List
Huge
Large
Normal
Small
Ok
Ok
21
Medical ConditionsPlease Explain
Huge
Large
Normal
Small
Ok
Ok
22
Health CertificationI believe, to the best of my knowledge, the above-named player to be in good health, (suffering from no illness and able to participate in all types of athletic activity, which demands physical exertion and stamina), and has not been exposed to any infectious disease. It is understood that, except first-aid treatment, Ascend Hockey Camp/Paul Lamoureux will accept no responsibility or liability for accident or illness incurred by the player during the camp program(s). I hereby give my approval for emergency medical treatment, if required. I also agree to have in place complete and current health insurance for the above-named player during the registered program week(s).
YESNO
23
Photo/Media Release I hereby grant to Ascend Hockey and his legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of me or my children, or in which I may be included, for editorial, trade, advertising and any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. I hereby release Photographer and his legal representatives and assigns from all claims and liability relating to said photographs.
YESNO
24
Minor Release (If registering someone under the age of 18)In consideration of my engagement as a model, and for other consideration herein acknowledged as received, I hereby grant to Paul Lamoureux and Ascend Hockey, LLC legal representatives and assigns, successors in interest, those for whom Photographer is acting, and those acting with his authority, and permission, the irrevocable and unrestricted right and permission to copyright, in his own name or otherwise, and use, re-use, publish, and re-publish photographic portraits or pictures of me or in which I or my children may be included, in whole or in part, including but not limited to composite or distorted in character or form, without restriction as to changes or alterations, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any medium at his studios or elsewhere, and in any and all media now or hereafter known for illustration, promotion, art, editorial, advertising, trade, or any other purpose whatsoever. I also consent to the use of any printed matter in conjunction therewith. I hereby waive any right that I, or the minor may have to inspect or approve the finished product or products or the advertising copy or printed matter that may be used in connection therewith or the use to which it may be applied. I hereby release, discharge, and agree to save harmless Photographer, his legal representatives or assigns, and all persons acting under his permission or authority or those for whom he is acting, from any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion of privacy. I hereby warrant that I am of full age and have every right to contract for the minor in the above regard. I state further that I have read the above authorization, release, and agreement, prior to its execution, and that I am fully familiar with the contents thereof. This release shall be binding upon Paul Lamoureux and Ascend Hockey, legal representatives, and assigns.
YESNO
25
How did you hear about Ascend Hockey Camps?
TV Ad
Camp Poster (Physical copy)
Instagram
Facebook Ad
Friend
Coach (email/text)
Other
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