Registration Form

	Adult Camp		(Boarding Fee/Day Fee)
	New Adult Camp Fort Myers Fl. Nov. 12-14, 2004		$275.00
	New Adult Camp Fort Myers Fl. April 1-3, 2004		$275.00
	Adult Camp August 14 - 20		$850.00 / $650.00
	Adult Camp August 21 - 27		$850.00 / $650.00

	NHL Alumni Fantasy Camp		(Boarding Fee)
	NHL Alumni Fantasy Camp June 10-12		$2000.00
	USA Hockey Alumni Camp Aug. 19-21		$2000.00

Step 3 Fill Out Parental Consent Form.

In consideration of the acceptance of (Campers Name) as a student in Heartland Hockey Camps, the applicant agrees that Heartland Hockey Camps and / or their staff, coaches or employees will not be held responsible for any accidents or loss of personal property, however caused, and agree to release the Camp from all claims or damages which may arise as a result of such accidents or loss. It is further agreed that all risks attendant to watching and / or participating in the Heartland Hockey Camps are assumed by the student and his / her parents and / or guardian and this assumption is acknowledged, approved by the signature hereto.

We have read the foregoing, and have explained its meaning to our son / daughter, and agree to the terms and conditions stated. We the parents of the above signed applicant, give our consent to his / her participation in Heartland Hockey Camps.

___________________________________________________________________

Signature of Parent Date

Step 4 Print this form, Sign the Parental Consent Portion

Applications must be accompanied by a 50% deposit, in the form of a personal check, money order, or cashiers Check. The balance is due before May 1st. Payment in is also acceptable.

There will be a $20.00 late fee assessed after May 1, 2005

Mail this application and deposit to:

Heartland Hockey Camps

24921 Arena Dr.

Deerwood Minnesota 56444

Step 5 Press the Send to Heartland Button below, this will hold your reservation in the appropriate camp untill your deposit arrives.

(If your deposit does not arrive within 10 days, we will assume you are no longer interested, and cancel your reservation!!)

Use Your BACK Button to Return

Heartland Hockey Camps

24921 Arena Dr.
Deerwood, MN 56444
(218) 534-3298 Out of State Boardings (800) 945-7465
Fax (218) 534-3297
E-Mail: Steve@heartlandhockey.com

Email:
Campers Name:
Address:
City:	State: Zip:
Phone (Day)
Phone (Night)
Birthdate:		Age:
Height:		Weight:
Position:		Jersey Size:
Roommate Requested
Medical Insurance Co.
Medical Insurance No.
How Did You Hear About Heartland Hockey Camps?

	(Mite age approx 5-8 years)		(Boarding Fee/Day Fee)
	Mite Hockey Skills Camp June 12-18		$800.00 / $650.00
	Mite Hockey Skills Camp July 17-23		$800.00 / $650.00
	Mite Select July 31 - Aug. 6		$825.00
	* Mom or Dad Optional Fee		$675.00

	(Squirt age approx 8-10 years)		(Boarding Fee/Day Fee)
	Squirt June 12-18		$800.00 / $650.00
	Squirt Select June 19-June 25		$825.00 / $650.00
	Squirt Camp July 17 - July 23		$800.00 / $650.00
	Squirt Select Camp July 24 - July 30		Boarding $825.00
	Squirt Super Select Camp July 31 - Aug. 6		Boarding $850.00
	* Mom or Dad Optional Fee		Boarding $675.00

	(PeeWee age approx 10-12 years)		(Boarding Fee/Day Fee)
	PeeWee Camp June 12-18		$800.00 / $650.00
	PeeWee Select Camp June 19-June 25		$825.00 / $650.00
	PeeWee Select Camp June 26 - July 2		$825.00 / $650.00
	PeeWee Camp July 17 - July 23		$800.00 / $650.00
	PeeWee Select Camp July 24 - July 30		Boarding $825.00
	PeeWee Select Camp August 7 - August 13		Boarding $825.00
	PeeWee Super Select Camp August 7-13		Boarding $850.00
	* Mom or Dad Optional Fee		Boarding $675.00

	Girls Hockey Camp (No age restriction)		(Boarding Fee/Day Fee)
	Girls Hockey Camp June 19 - June 25		$800.00 / $650.00

	Bantam Hockey Camps (approximate age 12-14) years)		(Boarding Fee/Day Fee)
	Bantam Hockey Camp June 26 - July 2		$800.00 / $650.00
	Bantam Hockey Camp July 3 - July 9		Boarding $825.00
	Bantam Hockey Camp July 10 - July 16		Boarding $825.00
	Bantam Select 2-Week Camp July 3 - 16		Boarding $1650.00
	Bantam Super Select Camp July 24 - July 30		Boarding $850.00
	Bantam Select Camp July 31 - Aug. 6		Boarding $825.00
	Bantam Select Camp August 7 - 13		Boarding $825.00

	High School Hockey Camps Approximate age 15-18		(Boarding Fee)
	High School Camp July 3 - 9		Boarding $825.00
	High School 2 - week camp July 3-16		Boarding $1700.00
	High School Select Camp July 10-16		Boarding $850.00
	High School Super Select July 17 - July 23		Boarding $875.00

	Goalie Camp		(Boarding Fee)
	Goalie Camp June 26 - July 2		Boarding $800.00