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GOALIE INFORMATION
Student First Name
*
Student Last Name
*
Parent/Guardian Name
*
Contact Email 1
*
Contact Email 2
Mobile Phone Number
How did you hear about us?
Has anyone referred you?
SELECT YOUR TIME AND DAY
Prices do not include GST
NUMBER OF SESSIONS
*
6 SESSIONS - $150.00
12 SESSIONS - $250.00
TIME OF DAY? BETWEEN THE HOURS OF?
*
9:00 - 11;00 AM
11:00 AM - 1: 00 PM
1:00 - 3:00 PM
3:00 - 5:00 PM
5:00 - 7:00 PM
DAY OF WEEK?
*
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
GOALIE INFORMATION
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
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
GOALIES OBJECTIVE WITH PROGRAM?
*
PAYMENT INFORMATION
Payment Options
*
Full Payment
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
Enter the word in the image.
*
*
I/we acknowledge that I/we have read the GITN Waiver, Terms & Conditions link below.
GITN Waiver, Terms & Conditions