On Target Hockey's Registration Form

REGISTRATION FORM

Printable Version

Student INFORMATION

Student’s last name:

First:

Middle:

Name of Parent/Guardian (if under 18)

Level of Play:

Catches:

Birth Date:

Age:

Sex:

House Travel High School Junior Other

Right Left

Male Female

Street address:

Home phone no.:

City:

State:

ZIP Code:

E-mail:

Location Selected & Discount Code:

Program Selected:

Regular Advanced Dry Land

Jersey Size:

Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL

Would you like to order your DVD in advance?

Yes No

Note: DVD is Free if you register by the early registration deadline for the selected location.

(Please include additional fee of $30 in payment if applicable)

IN CASE OF EMERGENCY
Name of local friend or relative:	Relationship to student:	Home phone no.:	Work phone no.:

The above information is true to the best of my knowledge. I acknowledge payment is non-refundable, and must be made to guarantee registration. In the case of a cancelled camp location, a refund will be made or admission to an alternative location granted. A processing fee of $10.00 will be charged on refunded electronic payments. To make a credit card payment or set up a payment schedule, please contact us by phone at (269) 830-1448. Check or money order may be mailed to: On Target Hockey, 135 Mathews Street #3, Fort Collins, CO, 80524. Please attach a printed copy of this form with payment. Printable Version