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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
*
2017
2018
2019
2020
2021
2022
Medical Coverage Number
Parent/Guardian Name
*
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
*
METRO VANCOUVER SUMMER CAMP CONFIRMATION
Please select a camp below. Prices do not include GST
Pitt Meadows, BC: July 5-9, 2021 Location: Pitt Meadows Arena Complex
Regular Program - $545
Intermediate Program - $605
Advanced Level 1 - $805
Advanced Level 2 - $805
Elite Level 1 - $1005
Elite Level 2 - $1005
Elite + MTC - $1380
Private Camp - $2500
Pitt Meadows BC: July 12-16, 2021 Location: Pitt Meadows Arena Complex
Regular Program - $545
Intermediate Program - $605
Advanced Level 1 - $805
Advanced Level 2 - $805
Elite Level 1 - $1005
Elite Level 2 - $1005
Elite + MTC - $1380
Private Camp - $2500
GOALIE INFORMATION
Goalie Jersey Size
Small (Regular/Intermediate)
Medium (Advanced Level 1/ Elite Level 1)
Large (Advanced Level 2/Elite Level 2/MTC)
XL (Advanced Level 2/Elite Level 2/MTC)
League Level of Play
*
Competitive
Recreational
Current Level of Play
*
Initiation
Novice
Atom
Peewee
Bantam
Midget
Junior
College
Professional
Adult
Returning Student
*
Yes
No
GITN Camps (Years)
*
1st Year
2nd Year
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
PAYMENT INFORMATION
Payment Options
*
Full Payment
50/50 (50% at time of deposit/balance due June 1st)
4 Equal Payments (On or Before June 1)
Monthly Payment Plan - 1st of the Month (On or Before June 1)
Camp Refund Option (5% of camp fees)
*
Yes
No
What is this?
Payment Method
*
Visa
Master Card
American Express
E-Transfer
Cheque
Name on Card
Credit Card Type
Visa
MasterCard
CVV Number
Credit Card Number
Expiration Date (mm/yy)
Credit Card Billing State/Postal Code
Enter the word in the image.
*
*
I/we acknowledge that I/we have read the GITN-MV Waiver, Terms & Conditions link below.
GITN Waiver, Terms & Conditions