*Name
 

*Parent/Guardian
 

*Address
 

*Email Address

*Postal Code
 

*Phone
 

*Age
 

*Birthday
Month/Day/Year
                              

Last Team Played On


Level                 Position           
      

Have You Attended this Camp Before
Yes / No
 

If yes How Many Years


All Camps July 16-20, 2012

*Please Choose Program Level Carefully

Beginners 5-8 Yrs $375.00      
Junior Elite 10-12 Yrs $475.00
Senior Elite 13-16 $475.00      
All Levels $425.00

(HST is included in all prices)
$100.00 non refundable deposit due with application
Chq. for balance (postdated July 1st, 2012) also due
Chq's payable to "Dupuis & Hefford Hockey School"

Mail chq's to Lori Dupuis & Jayna Hefford Hockey School
649 Fleet Street
Kingston, ON K7M 5A4