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GOALIE INFORMATION
Student First Name
*
Student Last Name
*
Contact Email 1
*
Contact Email 2
Student Birth Date
*
+
Gender
*
Male
Female
Summer Camp Year
*
2019
2020
2021
2022
2023
2024
Parent/Guardian Name
*
Medical Coverage Number
*
Medical Conditions/Medications/Allergies
How did you hear about us?
Has anyone referred you?
ADDRESS INFORMATION
Street Address
*
City
*
State/Province/Region
*
Zip/Postal Code
*
Home Phone Number
*
Mobile Phone Number
Country
*
ALASKA SUMMER CAMP CONFIRMATION
EAGLE RIVER, ALASKA:
JU
LY 10-14,2023
LOCATION: EAGLE RIVER ARENA
Youth Development Level 1 (U9) Beginner - $575 USD
Youth Development Level 2 (U9, U11) Intermediate - $730 USD
Advanced (U11, U13, U15) Competitive - $920 USD
Elite (U11, U13, U15, U17) Highly Competitive - $1300 USD
EAGLE RIVER, ALASKA:
AUGUST 7-11
,2023
LOCATION: EAGLE RIVER ARENA
Youth Development Level 1 (U9) Beginner - $575 USD
Youth Development Level 2 (U9, U11) Intermediate - $730 USD
Advanced (U11, U13, U15) Competitive - $920 USD
Elite (U11, U13, U15, U17) Highly Competitive - $1300 USD
PLAYER INFORMATION
Goalie Jersey Size
Small (U9)
Medium (U11)
Large (U13, U15)
XL (U15, U17, Jr., College)
League Level of Play
*
Competitive
Recreational
Current Level of Play
*
U9
U11
U13
U15
U18
U21
Junior
College
Professional
Adult
Returning Student
*
Yes
No
GITN Camps (Years)
*
0 Years
1 Year
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
PAYMENT INFORMATION
Payment Options
*
Full Payment
50/50 Payment
Monthly Payments (Processed the 1st of the Month)
Camp Refund Option (5% of camp fees)
*
Yes
No
What is this?
Payment Method
*
Visa
Master Card
E-Transfer
Name on Card
Credit Card Type
Visa
MasterCard
CVV Number
Credit Card Number
Expiration Date (mm/yy)
Credit Card Billing State/Postal Code
*
I/we acknowledge that I/we have read the GITN-AK Waiver, Terms & Conditions link below.
GITN-AK Waiver, Terms & Conditions
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