Ammerman Hockey School Registration

Ammerman Hockey School Registration
Player's Information
Last Name *
First Name *
Middle Name
Gender *

Male Female Prefer not to answer
Address *
City *
State *
Zip *
Birth Date *

Month Day Year
Please select a camp week

July 9-12 (Girls Only) July 16-19 (Boys & Girls) Both
Which days July 9-12 will your child be attending?

All 4 days Monday Tuesday Wednesday Thursday Not attending this week of camp
Which days July 16-19 will your child be attending?

All 4 days Monday Tuesday Wednesday Thursday Not attending this week of camp
Grade entering in the fall *
2017-2018 Team
Parent or Legal Guardian Information
Parent/Legal Guardian *
Relation *
Work Phone *

- Area Code Phone Number
Cell Phone *

- Area Code Phone Number
Home Phone

- Area Code Phone Number
Emergency Contact Info
Emergency Contact Name *
Emergency Number *

- Area Code Phone Number
Emergency Number #2 *

- Area Code Phone Number
Email Confirmation
Parents Email (player confirmation will be sent by email) *
Other Information
How did you hear about Ammerman Hockey School?
Health Information
Are immunizations up to date? *

Yes No
Date of last tetanus shot *
Any activity the camper should be restricted from? *
Any physical, mental or other condition that would require special attention or medication while at camp? *
List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers. *
List any allergies (ex: bees,peanuts, dairy) *
Camper Photo Release
I agree that photos of my child can be taken and used for camp social media purposes *

Yes No
Payment Information
Method of payment (if paying by check, please mail check or bring to camp)

Credit Card Check

Camp options (please note, credit card processing fee is included at checkout)

GOALIE Per Day July 9-12 $ 100.00

Quantity

July 16-19 All Four Days $ 450.00

July 16-19 Per Day $ 120.00

Quantity

July 16-19 Goalie All Four Days $ 350.00

GOALIE Per Day July 16-19 $ 100.00

Quantity

July 16-19 All Camp Sibling Discount $ 400.00

Quantity

July 16-19 Per Day Sibling Discount $ 110.00

Quantity

July 16-19 All Camp 1st week Player Discount $ 375.00

Quantity

July 16-19 Per Day 1st week Player Discount $ 100.00

Quantity

AHS Under Armour Tank $ 40.00

Tank Top

AHS Under Armour Longsleeve $ 40.00

Longsleeve Shirt

Adult GRAY AHS Under Armour T-Shirt $ 35.00

Adult T-Shirt

Youth GRAY AHS Under Armour T-Shirt $ 30.00

Youth T-Shirt

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Credit Card (only enter if paying via credit card)
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Be certain to enter your email address correctly on the registration form to receive confirmation via email within 2 weeks

If mailing check, send to:

Ammerman Hockey School

3 Marti Rd

Park Ridge, NJ 07656
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named player, and are over the age of 18. I certify that my child has my permission to attend camp and participate in all activites. (**you will be required to sign a liability form before the start of camp)
Electronic signature, please initials *
Should be Empty:

Ammerman Hockey School Registration

Player's Information

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Other Information

Health Information

Camper Photo Release

Payment Information