2019 Spring Camp Registration

Fields marked with * are required

Player Name *

Date of Birth (mm/dd/yr) *

Shoots *

Position *

Height (feet and inches) *

Weight (pounds) *

2018/19 Team & League *

Format: (team) - (league)

2017/18 Team & League *

Format: (team) - (league)

Address *

City *

Province / State *

Postal / Zip Code *

Country *

Player Email *

Player Phone *

Parent Email *

Parent Phone *

Medical Insurance *

Medical # *

Allergies

Leave blank if none

Emergency Contact *

Provide name and phone number

Credit Card Number *

Credit card will not be charged immediately. We will provide you with an online receipt when the payment is processed. If you would like to pay by cheque, please print out our registration form at the top of the page.

Expiration Date (mm/yr) *

CVV / Card Security Code *

Waiver *

I / We agree
I / We do NOT agree

I (we), being Parent(s) or Guardian(s) accept the terms of registration and agree that the staff, coaches, volunteers, instructors, along with the ice arena and its employees are not liable for, nor held responsible for any accident or loss, however caused, and agree to release same from all claims or damages. We further agree that the applicant has no medical problems and is in good physical health and we will be responsible for all medical and dental claims, or insurance. I (we) have read and understood this waiver.

2019 Coquitlam Express Spring ID Camp Online Registration