ASHA Northeastern District Summer Hockey Camp Registration Form

Player Information (Fields marked with a * are required)

First Name *

Last Name *

Date of Birth *

Gender *
Male Female

Email Address

Confirm Email Address

Telephone *

Street Address *

City *

Province / State *

Postal / Zip Code *

Citizenship (USA, Can, Other) *

Registered with USA Hockey? *
Yes
No

ASHA Team Affiliation *

If the Camp for which your child is registering has a swimming pool/swimming sessions, please select the appropriate option: *

Player/Coach? *

Player Jersey Size

Player Skill Level
Beginner
Intermediate
Advanced

Parent / Guardian Information

Name *

Email *

Confirm Email Address *

Home Phone *

Work Phone

Relationship *

Payment Options:
Pay Total: $0.00

Maximum number of Registrants: 150

Please read, print, sign and bring the following two USA Hockey forms to the first day of Summer Camp:

a. Waiver of Liability Form
b. Consent to Treat Form

ASHA Summer Hockey Camp Consent Form

I agree to abide by the rules of American Special Hockey Association and my affiliated USA Hockey Disabled/Special Hockey Team and agree to read, print, sign and bring the attached, signed USA Hockey “Waiver of Liability” and “Consent to Treat” Forms to the ASHA Summer Hockey Camp that my child will be attending.

Please check if you agree to the above terms.

(Fields marked with a * are required)