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
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
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Nigeria
Niue
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Poland
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eSwatini
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US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Emergency Contact Name
7
Emergency Contact Phone
Area Code
Phone Number
8
Parent Name
First Name
Last Name
9
Parent Phone
Area Code
Phone Number
10
Camp RegistrationChoose your camp registration. You can add more than one camp.
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My Camps
0
My Camps
Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
Twin Ponds PRO SKATING AND GOAL SCORING CAMPApril 1-2
$275.00+Edit
Back
Quantity
Subtotal: $0.00
Twin Ponds PRO SKATING AND GOAL SCORING CAMP SINGLE SESSIONApril 1-2
$75.00+Edit
Back
Quantity
Subtotal: $0.00
York PRO SKILLS AND 3 VS 3 DEVELOPMENT CAMPApril 8
$150.00+Edit
Back
Quantity
Subtotal: $0.00
The St.James PRO SKATING AND GOAL SCORING CAMPApril 10-12
$325.00+Edit
Back
Quantity
Subtotal: $0.00
New England Sport Center PRO SKATING AND GOAL SCORING CAMPApril 22-23
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Riz PURE CHECKING CAMPMay 1,3 and 5
$350.00+Edit
Back
Quantity
Subtotal: $0.00
Chilled Ponds PRO SKATING AND SKILLS CAMP (Beginner-Advanced)May 6-7
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Larry Grossman Forest Hill Memorial Arena ( Beginner-Intermediate)PRICE IN CAD May 20-21
$350.00+Edit
Back
Quantity
Subtotal: $0.00
Larry Grossman Forest Hill Memorial Arena ( Elite Challenge Group)PRICE IN CAD May 20-21
$350.00+Edit
Back
Quantity
Subtotal: $0.00
Leisure Rinks PRO SKATING AND SKILLS CAMPMay 22-24
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Paul Louis PRO SKATING AND SKILLS CAMP May 27-28
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Hampton Roads Iceplex PRO SKATING AND SKILLS CAMP May 30- June 1
$295.00+Edit
Back
Quantity
Subtotal: $0.00
Wake Forest PRO SKATING AND SKILLS CAMP ( Beginner-Intermediate) June 6-8
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Wake Forest PRO SKATING AND SKILLS CAMP ( Elite Challenge Group)June 6-8
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Chilled Ponds PRO GOAL SCORING CAMP (Beginner-Advanced)June 10-11
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Skate Frederick PRO SKILLS AND 3 vs 3 DEVELEOPMENT CAMPJune 19-22
$525.00+Edit
Back
Quantity
Subtotal: $0.00
Skate Frederick PRO SKILLS AND 3 vs 3 DEVELEOPMENT CAMP June 19-22 GOALIE FEE
$250.00+Edit
Back
Quantity
Subtotal: $0.00
Holiday Twin Rink PRO GOAL SCORING CAMP (Beginner-Advanced) JUNE 26-28
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Holiday Twin Rink PRO GOAL SCORING CAMP (Beginner-Advanced) *OPTIONJUNE 26-28
$375.00+Edit
Back
Quantity
Subtotal: $0.00
Hampton Road Iceplex PRO SKATING AND SKILLS CAMP (Beginner-Advanced) TBD
$295.00+Edit
Back
Quantity
Subtotal: $0.00
Wake Forest PRO SKATING AND GOAL SCORING CAMP (Beginner-Advanced) TBD
$325.00+Edit
Back
Quantity
Subtotal: $0.00
Holiday Twin Rinks 3 VS 3 DEVELOPMENT CAMPJuly 24-26
$325.00+Edit
Back
Holiday Twin Rinks 3 VS 3 DEVELOPMENT CAMP *OPTIONJuly 24-26
$375.00+Edit
Back
Leaside Memorial Gardens PRO SKATING AND GOAL SCORING CAMPPRICE IN CAD July 31-August 2
$425.00+Edit
Back
Quantity
Subtotal: $0.00
Riz 3 vs 3 Development CampAugust 12-13
$325.00+Edit
Back
Riz 3 vs 3 Development Camp OPTIONAugust 12-13
$375.00+Edit
Back
3 vs 3 Development Camp Hampton Roads Ice PlexTBD
$295.00+Edit
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
$350.00+Edit
Back
Total cost $0.00
11
Parent Email
example@example.com
12
Insurance Provider
13
Policy Number
14
Group Number
15
Policy Holder Name
16
AllergiesPlease List
Huge
Large
Normal
Small
Ok
Ok
17
Medical ConditionsPlease Explain
Huge
Large
Normal
Small
Ok
Ok
18
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
19
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
20
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
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