Week Attending*—Please choose an option—July 24th-28th, 2023July 31st-August 4th 2023
Gender* —Please choose an option—MaleFemale
Date Of Birth*
Name of Parent Paying*
Province —Please choose an option—ONTQUEMANMIOHNI
Postal Code / ZIP*
Jersey Size —Please choose an option—Youth Small/MediumYouth Large/Extra LargeAdult SmallAdult MediumAdult LargeGoalie IntermediateGoalie Senior
Level—Please choose an option—InitiationNoviceAtomPeeweeBantamJuvenileJuniorSeniorHouseUnknown
Position—Please choose an option—GoalDefenseCenterL WingR WingCenter-WingDefense ForwardUnknown
Shoots—Please choose an option—RightLeft
Health Card Number*
By clicking Submit you agree to the conditions below.
The applicant agrees that neither Agosta’s High Performance Hockey Academy nor the venues will not be held responsible for any losses or accidents. I agree to permit the use of my child’s image in photos on websites, or other media coverage and agree not to make claims for breach of privacy.