Puckstoppers Summer Goalie Development Programs
On Ice Sessions with Expert Instructors
MUST COMPLETE ALL SECTIONS BELOW
Payment by E-Transfer is PREFERRED
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YES - I will immediately submit payment by e-transfer to dys00@rogers.com
Complete this form and immediately submit payment to dys00@rogers.com (payment must be submitted within 1-hour of order submission)
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FUNDAMENTALS Goaltending Development Program
Specifically designed for 7 to 11-year-old goalies - 1/2 day program.
$
349.95
CAD
EARLY BIRD BONUSES - ONLY apply until April 15th.
I am ordering before April 15th - apply EARLY BIRD BONUSES
I am ordering AFTER April 15 - E.B. bonuses DO NOT apply
ESSENTIALS Goaltending Development Program
Our Most popular program. For all ages and skill levels.
$
599.99
CAD
EARLY BIRD BONUSES - ONLY apply until April 15th.
I am ordering BEFORE April 15 - Apply EARLY BIRD BONUSES
I am ordering AFTER April 15 - E.B. bonuses DO NOT APPLY
INTENSITY PREP or HIGH INTENSITY Goaltending Development Programs
2 OPTIONS: Created for competitive and elite-level goaltenders aged 10 and up.
$
699.99
CAD
EARLY BIRD BONUSES - ONLY apply until April 15th.
INTENSITY PREP - I am ordering BEFORE April 15 - Apply EARLY BIRD BONUSES
INTENSITY PREP - I am ordering AFTER April 15 - E.B. bonuses DO NOT APPLY
HIGH INTENSITY - I am ordering BEFORE April 15 - apply EARLY BIRD BONUSES
HIGH INTENSITY - I am ordering AFTER April 15 - E.B bonuses DO NOT APPLY
MUST COMPLETE ALL SECTIONS BELOW
Important Info:
PLEASE NOTE: You must receive an email that states: Puckstoppers SCHOOL confirmation. Please DO NOT consider your registration confirmed or booked until you receive this message. PLEASE BE SURE TO READ THE 'TERMS AND CONDITIONS' AND UNDERSTAND OUR POLICIES.
Goalies Full Name
*
First Name
Last Name
Preferred Email - For Communications
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example@example.com
Contact Number - Cell
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Goalies Birthdate
*
Month/Day/Year
Sex
*
Please Select
Male
Female
Height
*
Weight
*
Health Card Number
*
Highest Level Played
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New To Game
House League
MD / A
AA
AAA
Other Competitive
Adult Recreational
Junior (Jr, A,B,C,D)
Years Playing Goal
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Less Than 1
2 to 5
6 to 10
10+
Emergency Contact (Name and Phone)
*
Any Medical Conditions?
*
I AGREE to ALL Terms, Conditions and Refund Policies, and have reviewed them.
*
Please Select
Yes, I agree please process my order
No, I do not agree - Order will not be processed
I understand that my program registration is NOT CONFIRMED until I receive an email from puckstoppers.com, with the subject line 'Puckstoppers School Confirmation' and showing the specific time and date being confirmed.
*
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I understand and will not attend until I have received the confirmation email.
I do not agree to wait for the confirmation - your session will NOT be booked if you arrive without receiving the confirmation.
How Did You Hear of Us?
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Returning Player
Web Search
Referral
Social Media
Flyer in Arena
Submit Order
NOTES: Do NOT Enter Questions Here, Email Any Questions to Us At info@puckstoppers.com
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