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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
2025
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
*
VANCOUVER ISLAND SUMMER CAMPS
Please select a camp below. Prices do not include GST
Victoria BC: July 17 - 21, 2023 Location: Westhills Arena
Youth Development Level 1 (U9) Beginner - $550 + GST
Youth Development Level 2 (U9, U11) Intermediate - $600 + GST
Advanced (U11, U13, U15) Competitive - $700 + GST
Elite (U11, U13, U15) Highly Competitive - $990 + GST
Pro Development (U13, U15, Jr.) Extreme Competitive - $1400 + GST
Victoria BC: July 17-20, 2023 Location: Westhills Arena
(Adult Camp)
Adult Camp - $299 + GST
Victoria BC: July 24-28, 2023 Location: Pearkes Arena
Youth Development Level 1 (U9) Beginner - $550 + GST
Youth Development Level 2 (U9, U11) Intermediate - $600 + GST
Advanced (U11, U13, U15) Competitive - $700 + GST
Elite (U11, U13, U15) Highly Competitive - $990 + GST
Intensive Pro Development (U13, U15, Jr., College, Pro) Ultra Intensity- $1650 + GST
Parksville BC: July 31 - Aug 4, 2023 Location: Oceanside Place Arena
Youth Development Level 1 (U9) Beginner - $550 + GST
Youth Development Level 2 (U9, U11) Intermediate - $600 + GST
Advanced (U11, U13, U15) Competitive - $700 + GST
Pro Development (U13, U15, Jr.) Extreme Competitive - $1400 + GST
Intensive Pro Development (U13, U15, Jr., College, Pro) Ultra Intensity - $1650 + GST
Parksville BC: August 7-10, 2023 Location: Oceanside Arena
(Adult Camp)
Adult Camp - $299 + GST
Parksville BC: August 7-11, 2023 Location: Oceanside Place Arena
Youth Development Level 1 (U9) Beginner - $550 + GST
Youth Development Level 2 (U9, U11) Intermediate - $600 + GST
Advanced (U11, U13, U15) Competitive - $700 + GST
Elite (U11, U13, U15, U17) Highly Competitive - $990 + GST
Intensive Pro Development (U13, U15, Jr., College, Pro) Ultra Intensity - $1650 + GST
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 (7 & 8 Years)
U11 (9 & 10 Years)
U13 (11 & 12 Years)
U15 (13 & 14 Years)
U18 (15 - 17 Years)
U21 (18-21 Years)
Junior
College
Professional
Adult
Returning Student
*
Yes
No
GITN Camps (To Include this year)
*
1st Year
2nd Year
3rd Year
4th Year
5th Year
6th Year
7th Year
8th Year
9th Year
10th Year
Are you a member of
Cowichan Valley Minor Hockey
Comox Valley Minor Hockey
Campbell River Minor Hockey
PAYMENT INFORMATION
Payment Options ( Prior to June 1st)
*
Full Payment
50/50 ( 50% down/ 50% June 1)
Monthly Auto Payments (deposit pymt @ time of registration, remaining payments 1st of the month, last payment June 1st))
Camp Refund Option (5% of camp fees)
*
Yes
No
What is this?
Payment Method
*
Visa
Master Card
E-Transfer (to vi@goldinthenet.com) Comments Box Students Name and Camp
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 Waiver, Terms & Conditions link below.
GITN Waiver, Terms & Conditions
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