Spring Camp 2017 - Registration Form
Mailing Address: 117 Chatillon, Dollard Des Ormeaux, Quebec, H9B 1B4
Telephone Number: 514-941-8404
E-mail: evan@sport-life.ca
Website: www.sport-life.ca
CAMPER
Please send a digital picture of your child to evan@sport-life.ca (new campers only).

This image will be used for our Monday Draft.

First Name *
Your answer
Last Name *
Your answer
Gender *
Required
Date of Birth *
MM
/
DD
/
YYYY
Age *
(as of March 1, 2017)
Your answer
Home Address *
Your answer
City *
Your answer
Postal Code *
Your answer
School *
Your answer
Grade *
Your answer
Ice Hockey Position *
(Forward, Defense or Goalie)
Your answer
Ice Hockey Level (Current Season) *
Example: Atom BB, Peewee A, etc.
Your answer
PARENTS
Camp fees are tax deductible. Please provide the full name of both parents and either the mother's OR father's social insurance number, as it appears on their social insurance card for tax receipt purposes (Releve 24).
Mother's Name *
Your answer
Social Insurance Number
Your answer
Father's Name *
Your answer
Social Insurance Number
Your answer
PHONE NUMBERS & E-MAIL
Home
Your answer
Mother Work Phone
Your answer
Mother Cell Phone
Your answer
Mother E-mail *
Your answer
Father Work Phone
Your answer
Father Cell Phone
Your answer
Father E-mail *
Your answer
EMERGENCY CONTACT
(other than parents)
Name
Your answer
Relationship to Child
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
LANGUAGES
First Language
Your answer
Languages Spoken
Your answer
GENERAL INFORMATION
Are there any special friends that you would like to have in your child's group?
Your answer
Allergies, medications being taken and/or other pertinent medical information
Your answer
Is there any other information that you think we should know about?
Your answer
HOW DID YOU HEAR ABOUT US? *
Required
REGISTRATION PAYMENT
Method of Payment *
e-Transfer (preferred), cheque or cash
Your answer
Name on Cheque
Your answer
Cheque #
Your answer
Amount *
Your answer
INSTRUCTIONS & PERTINENT INFORMATION
TERMS & CONDITIONS
The parties hereto have agreed that this agreement be prepared and executed in the English language.
Les parties ont convenu que cet accord soit préparé et exécuté dans la langue anglaise.
Parent's Name *
Your answer
Date *
Your answer
E-mail Address *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.