REGISTRATION - Youth  Summer Camps 2023

Please complete this form and then print it out in landscape format on letter paper. You can then either fax it to us on 416-392-1061 or send it to us at 140 Sherbourne Street, Toronto, M5A 2R6 or even call in and drop it off at our office. Cheques should be made out to Moss Park Arena. We do not except postdated cheques.

Name		The participant is responsible for his/her own medical coverage. I hereby give permission to have staff arrange for any emergency care including hospitalization if necessary. In all instances where children are involved, an attempt will be made to contact parents or guardian first. I release Moss Park Arena, and/or its agents from all claims or damages which may arise from participation in this activity. ---------------------- Signature of Participant, Parent or Guardian. Full hockey equipment is required for all programs. CANCELLATIONS No cancellations will be allowed after registration is processed. Exceptions can only be made for medical reasons and must be accompanied by a doctor’s certificate. All cancellations will be subject to a $30 administration fee.
Address
City
Postcode
Email Address
Tel. (Home)
Tel. (Work)
Date of Birth
Gender	Male Female
Health Card #
Program	MPAY01 - Summer Camp 1 MPAY02 - Summer Camp 2 MPAY03 - Summer Camp 3 MPAY04 - Summer Camp 4 MPAY05 - Summer Camp 5 MPAY06 - Summer Camp 6 MPAY07 - Summer Camp 7
Fee	MPAY01 - $335 MPAY02 - $335 MPAY03 - $335 MPAY04 - $335 MPAY05 - $335 MPAY06 - $335 MPAY07 - $335
Camp Meal Plan	YES [add $50] NO
Amount Paid
Payment Method	Cheque Visa Mastercard Amex
Visa No.
Expiry Date
Name on Card
Card Holder Signature