Registration
Registration Form 2017
  1. Name:(*)
    Please input a Name.
  2. Email:(*)
    Please input a valid Email.
  3. Birthday:
    Invalid Input
  4. School:
    Invalid Input
  5. Grade:
    Invalid Input
  6. Position(s):
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  7. Participated Before?
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  8. Age Started:
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  9. Any skills you would like to focus on?
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  10. Favorite Athlete:
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  11. Do you play any other sports?
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  12. Street:(*)
    Please input a Street.
  13. City:(*)
    Please input a city.
  14. State:(*)
    Please input a State.
  15. Zip:(*)
    Please input a Zip Code.
  16. Total: $0
  17. List any Medical Conditions that camp personnel should be aware of:
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  18. List any medication currently taking:
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  19. List any Allergies:
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  20. Medical Waver(*)
    You must Agree to the Medical Waver
  21. In case of emergency please contact:
  22. Daytime Name:(*)
    Please input a Emergency Daytime Name.
  23. Daytime Phone:(*)
    Please input a Emergency Daytime Phone.
  24. Nighttime Name:(*)
    Please input a Emergency Nighttime Name.
  25. Nighttime Phone:(*)
    Please input an Emergency Nighttime Phone.
  26. Insurance Company Name:(*)
    Please input Insurance Company Name.
  27. Insurance Company Phone:(*)
    Please input Insurance Company Phone.
  28. Insurance Policy Number:(*)
    Please input an Insurance Policy Number.
  29. Insurance Policy Holder:(*)
    Please input an Insurance Policy Holder.
  30. Liability Waver(*)
    You must Agree to the Medical Waver
  31. Billing First Name:
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  32. Billing Information Note: (You must provide the correct billing information for your card or your transaction will be declined)
  33. Billing Last Name:
    Invalid Input
  34. Billing Address:
    Invalid Input
  35. Billing City:
    Invalid Input
  36. Billing State:
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  37. Billing Zip:
    Invalid Input
  38. Card Type:
    Invalid Input
  39. Card Number:
    Invalid Input
  40. Card Expiration:
    Invalid Input
  41.  
    Invalid Input
  42. CVV Code:
    Invalid Input
  43. Total: $0
 

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Elite Connection supports our troops, Amateur Athlete Scholarship Fund and 3PC the USA National Field Hockey Team Players Club

*No refunds. Camp will be held rain or shine.