Registration

Name

Athlete's Name:

First Name

Last Name

Email:

Phone #

Phone Number:

Address

Address (Inc. City & Postal Code):

Age

Age:

Grade

Present Grade:

QB or Receiver

Camp You Would Like to Register For

Camp You Would Like to Register For (Inc. Date):

Team

Team You Play For:

Coach

Your Coach:

T-Shirt Size

T-Shirt Size (Inc. Adult or Child):

Consent

I give my son/daughter permission to attend the Jay Prepchuk camp.

Yes.

Method of Payment

Method of Payment:

E-Transfer (payment to jayprepchuk@gmail.com)

Cheque (Please Mail to 451 West 16th St., North Vancouver, BC, V7M 1V1)

Cash

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