Goalie Action Training Camp Registration

Athlete Information

Athlete First Name *

Athlete Last Name *

Gender *

Most Recent Level of Play *

DOB * +

Athlete Personal Information

Allergies

Relevant Medications

Health Conditions

Health Insurance Carrier *

Policy Number *

Athlete Contact Information

Phone Number

Email Address

Guardian / Emergency Contact Information

Relationship to Athlete *

Parent

Guardian

Athlete

Other Other

Name *

Phone *

Email Address *

Payment Options

Payment must be finalized in order to secure your spot at camp and to receive confirmation of roster spot. Payment must be received prior to the beginning of camp to guarantee a spot. Thank you for your understanding.

Refunds will be provided on a case to case basis, refunds are NOT guaranteed. Any cancellation due to restrictions made by the State, County, or Rink will result in a full refund of camp.

Select camp(s) to attend: *

June 24-25, 2021 ($275.00)

July 19-21, 2021 (425.00)

August 4-8, 2021 (575.00)

Payment Due:

$0.00

Select payment option (disclaimer: credit card payments will be given a 3% processing fee) *

Apple Pay*

Venmo**

Cash or Check***

Apple Pay* - payments done through Apple Pay will be done directly with Artt Brey at 714.356.8004, please text payment in order to confirm registration

Venmo**

Venmo Account Handle (@username)

Credit Card Information*** - fill out if credit card payment option was selected.

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