Registration Form

	Adult Camp		(Boarding Fee/Day Fee)
	Adult Camp Oct. 5-7, 2007 Fort Myers Fl.		Day Fee $375.00
	Adult Camp Dec. 14-16, 2007 Fort Myers Fl.		Day Fee $375.00
	Adult Camp May 2-8, 2008 Fort Myers Fl.		Day Fee $375.00
	Adult Camp Aug. 17-23, 2008 Deerwood Mn.		Boarding $ 975.00

	Youth Hockey Checking / Shooting Clinic		(Boarding Fee/Day Fee)
	Youth Hockey Checking Clinic April 25 - 27, 2008 Fort Myers Fl.		Day Fee $975.00

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 advance is also acceptable.

There will be a $20.00 late fee assessed after May 1, 2008

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 (825) 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 15-21		$900.00 / $750.00
	Mite Hockey Skills Camp July 20-26		Boarding $900.00
	Mite Select Aug. 3-9		Boarding $950.00

	(Squirt age approx 8-10 years)		(Boarding Fee/Day Fee)
	Squirt June 15-21		$900.00 / $750.00
	Squirt Select June 22-June 28		$950.00 / $775.00
	Squirt Camp July 20 - July 26		Boarding $900.00
	Squirt Select Camp July 27-Aug. 2		Boarding $950.00
	Squirt Super Select Camp Aug. 3-9		Boarding $975.00

	(PeeWee age approx 10-12 years)		(Boarding Fee/Day Fee)
	PeeWee Camp June 15 - 21		$900.00 / $750.00
	PeeWee Select Camp June 22 - June 28		$950.00 / $775.00
	PeeWee Select Camp June 29, July 5		$950.00 / $775.00
	PeeWee Camp July 20 - July 26		Boarding $900.00
	PeeWee Select Camp July 27 - Aug. 2		Boarding $950.00
	PeeWee Select Camp August 10 - August 16		Boarding $950.00
	PeeWee Super Select Camp August 10 - 16		Boarding $975.00

	Bantam Hockey Camps (approximate age 12-14) years)		(Boarding Fee/Day Fee)
	Bantam Hockey Camp June 29 - July 5		$900.00 / $750.00
	Bantam Hockey Camp July 6 - July 12		Boarding $950.00
	Bantam Hockey Camp July 13 - July 19		Boarding $950.00
	Bantam Select 2-Week Camp July 6 - 19		Boarding $1925.00
	Bantam Super Select Camp July 27 - Aug. 2		Boarding $975.00
	Bantam Select Camp August 3 - 9		Boarding $950.00
	Bantam Select Camp August 10 - 16		Boarding $950.00

	High School Hockey Camps Approximate age 15-18		(Boarding Fee)
	High School Camp July 6 - 12		Boarding $925.00
	High School 2 - week camp July 6 - 19		Boarding $1975.00
	High School Select Camp July 13 - 19		Boarding $975.00
	High School Super Select July 20 - July 26		Boarding $1000.00

	Goalie Camp		(Boarding Fee/Day Fee)
	Goalie Camp June 29 - July 5		Boarding $900.00

	Girls / Women Hockey Camp (No age restriction)		(Boarding Fee/Day Fee)
	Girls / Women Hockey Camp June 15 - June 21		$900.00 / $750.00
	Girls / Women Hockey Camp June 22 - June 28		$900.00 / $750.00

Mom or Dad (Optional) Full Service Fee	$775.00
Mom or Dad (Optional) Lodging, Meals & No Ice Fee	$675.00
Mom or Dad (Optional) No Boarding, Ice & Meals Only Fee	$575.00