GOALIE CENTRE 2011 SUMMER CAMPS NAME: ____________________________________________________________ ADDRESS: _________________________ CITY _________________________ POSTAL CODE: __________________ DATE OF BIRTH: __________________ HOME PHONE #: __________________ CELL PHONE #: ___________________ LEVEL OF HOCKEY IN 2011/2012 SEASON: _____________________________ PARENTS: _________________________________________________________ WEEK OF CAMP: ____________________________________________________ EMAIL ADDRESS: ___________________________________________________ PAYMENT A $300.00 (non refundable) deposit must accompany your registration form. Please indicate whether you are paying the deposit or the full amount with your registration form. A post dated payment for June 1,2011 must also accompany your registration form. Also indicate if post dated payment will be made by credit card and include the number if necessary. MASTERCARD: _________________ EXP: ________________ POST DATE: ___ VISA: _______________________ EXP: ________________ POST DATE: ___ CHEQUE(S): _________________________________ CHQ#(S): ____________ Please mail or fax to: 780-922-0024 OR 22130 Twp Rd 514 Sherwood Park Alberta T8E 1H1 Book early as spaces are limited this year! The Goalie Centre and its employees are not responsible for lost or stolen items. The Goalie Centre reserves the right to terminate the program of any goaltender that does not display the appropriate behaviour or attitude, with no refund! Due to past problems, the Goalie Centre will not be offering refunds, this year if you need to withdraw from camp you will receive a training credit, less your $300.00 non refundable deposit. All goaltenders are responsible for their own equipment, water bottles, and dryland training clothes. All goaltenders must provide their own lunch and snack items. SNACK ITEMS: Granola Bars Muffins Crackers and cheese NO POP, CHIPS, OR CHOCOLATE Rice / Popcorn cakes Fruit Juice Boxes DRYLAND Shorts T-Shirt Extra socks Extra underwear Toiletries for showering Towel Applications will be screened due to the small numbers in our camp.