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Player Information  
First Name:
Last Name:
Birthdate: Day    Month    Year   
Address:
City:   State / Prov.
Postal / Zip Code :
Email:
Telephone:
Position (Check one): All  Forward  Defense  Goalie 
Height:  Inches:
Weight:
Shot: Left  Right
Please indicate the division played in 2007/2008 season:
Name of Association:
Hockey Level: House  Rep Level
  Tyke   Atom  Peewee  Bantam
All players will be supplied Pacific Elite Hockey School jerseys as well as a commemorative "Pacific Elite Hockey School" Hat.
Emergency Contact & Information
Medical Conditions :
Medical Insurance #:
Parent's Name:
Home Phone:
Emergency Contact:
Home Phone:
Payment Information
Cash (Do not mail)    Cheque  Visa  Mastercard
Card Holder Name:
Credit Card #:
Expiration Date:
Email (for confirmation):
Fax (for confirmation):
Course Level Requested:
  Richmond Ice Centre
Future Stars ( 2001-2003 )………………................$199.00
Rising Stars ( 2001-2002 )…………........................$299.00
Rising Stars ( 1999-2000 ) ………….......................$299.00
Superstars ( 1998-1999 ) …………….....................$399.00
Superstars ( 1996-1997 ) …………….....................$399.00
Superstars (1993-1995 ) ……………...............…...$399.00
  Sunset Rink Vancouver Sessions
Elite Power Performance ( 2000-2001 ).................$169.00 + GST
Elite Power Performance ( 1998-1999 ).................$169.00 + GST
Elite Power Performance ( 1996-1997 ).................$169.00 + GST
Elite Power Performance ( 1994-1995 ).................$169.00 + GST
   
 

A 50% Depost 'must' accompany the application by cheque
 

Balance is Due by July 11, 2008
 

MAIL TO: Pacific Elite Hockey School
5812-122nd St, Surrey, B.C V3X 3L5

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