HPT Summer Program
July 2 - August 24
Age Group
*
Please Select
Junior (05,06,07,08)
U17 (08,09,10)
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Position
*
Please Select
Forward
Defense
Goalie
Shoots
*
Please Select
Left
Right
Current Team and Level
*
Healthcare Number
*
Medical Conditions or Allergies
*
Parent Contact Name
*
Parent Contact Phone Number
*
Please enter a valid phone number.
Parent Contact Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment
*
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HPT Summer
$
2,180.00
CAD
HPT Summer 2 Weeks
$
550.00
CAD
Credit Card
Submit
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