Next Level Hockey Player Application Form 2012

Please complete all information requested.

Player Information
First Name: Gender: M: F:
Last Name: Height:
Address:
Weight:
City:
Date of Birth: (mm/dd/yy)
Prov/State:
Position:
 Goalie: Defense: Forward:
Postal/Zip Code:
 Minor Hockey Assoc.
Jersey Size:
Youth: L        
Adult: S M L XL XXL
Experience Level:
 B/A/AA/AAA Rep Player
Recreational Player
Inexperienced Player



Next Level Hockey Program Selections for 2012
VICTORIA - TOP GUNS (40 Hours On Ice)
DATES
DURATION
COSTS
Novice
April to June
40 Hours
$ 675.00
Atom
April to June
40 Hours
$ 675.00
PeeWee
April to June
40 Hours
$ 675.00
Bantam
April to June
40 Hours
$ 675.00
Junior Prep - Ages 15 - 19
April to August
40 Hours
$ 550.00
VICTORIA - AUGUST CAMPS (Week 1) August 6-10
DATES
DURATION
COSTS
Novice
August
10 Hours
$ 375.00
Atom
August
10 Hours
$ 375.00
PeeWee
August
10 Hours
$ 375.00
Bantam
August
10 Hours
$ 375.00
Midget
August
10 Hours
$ 375.00
VICTORIA - AUGUST CAMPS (Week 2) August 13-17
DATES
DURATION
COSTS
Novice
August
10 Hours
$ 375.00
Atom
August
10 Hours
$ 375.00
PeeWee
August
10 Hours
$ 375.00
Bantam
August
10 Hours
$ 375.00
Midget
August
10 Hours
$ 375.00
VICTORIA - AUGUST CAMPS (Week 3) August 20-24
Kerry Park Arena (Mill Bay)
DATES
DURATION
COSTS
Novice
August
12.5 Hours
$ 375.00
Atom
August
12.5 Hours
$ 375.00
PeeWee
August
12.5 Hours
$ 375.00
Bantam
August
12.5 Hours
$ 375.00
Midget
August
12.5 Hours
$ 375.00
WINTER CLINICS
DATES
DURATION
COSTS
Session l- Stickhandling
Oct/Nov
8 Hours
$ 240.00
Session ll- Stickhandling
Nov 2010- Feb 2011
8 Hours
$ 240.00
Session lll- Adv Forward & Defenseman
Oct/Nov
8 Hours
$ 240.00
Session lV- Adv Forward & Defenseman
Dec 2010- Feb 2011
8 Hours
$ 240.00


Family Information
Father:
Mother:
Home Phone:
Home Phone:
Bus. Phone:
Bus. Phone:
Fax:
Fax:
Mobile/Pager:
Mobile/Pager:
Email: Email:



Emergency Contact Information (other than parent)
Full Name:
Relationship to Player:
Home Phone:
Work Phone:
Mobile/Pager: