DEV27 Summer Program
Player 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
*
Medical Conditions or Allergies
Player Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Player Email
example@example.com
Parent 1 Name
*
Parent 1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent 1 Email
*
example@example.com
Parent 2 Name
Parent 2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent 2 Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment
*
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( X )
DEV27 - 5 Day Program
$2,800.00 CAD
$
2,800.00
CAD
DEV27 - 3 Day Program
$1,400.00 CAD
$
1,400.00
CAD
DEV27 - 2 Day Program
$1,200.00 CAD
$
1,200.00
CAD
Credit Card
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