Camp Registration - Halton Roller Hockey

Summer Camp Registration

Player Name

Player Birth Date

If any allergies or health problems please describe below

Parent / Guardian Info

Parent / Guardian Name

Parent / Guardian Email

Parent / Guardian Phone 1

Parent / Guardian Phone 2

Emergency Contact

Emergency Contact Name (Other than Parent / Guardian Above)

Emergency Contact Phone (Other than Parent / Guardian Above)

Additional Info

Payment & Waiver

Click here to read waiver (opens in a new window, make sure popup blockers are disabled)

Accept Waiver

I have fully read and fully understood the Halton Roller Hockey waiver form

Signature

By writing my name into the signature box, I understand that my child will be participating in roller hockey at Halton Roller Hockey, I understand all the risks attached to the sport in which my child will participate.

Payment

Price$389.00

Payment

Discount

Subtotal

Tax

Total CAD