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SSAC Summer Camp 2021

Player – First Name *

First Name - Title Case, e.g. Connor

Player – Last Name *

Last Name - Title Case, e.g. McDavid

Phone *

000-000-0000

EMail *

Contact Email Address

Birthdate *

mm/dd/yyyy
*** Select birth year then month-day ***

Height *

Weight *

Address *

Address

e.g. 11100 - 123 Street NW

Address

City

Province

Postal Code e.g. T6T 1E1

Complete Street Address, City, Province, Postal Code

Position *

Goalie

Defence

Forward

Defence/Forward

Shoots *

Left

Right

AGE CATEGORIES

Please select one
U13 | U15
U16 | U18

A) U13 Peewee Sessions | 11-12 year old
Week 1 August 9-13 | Early Evening Sessions
Week 2 August 16-20 | Noon-Afternoon Sessions
Week 3 August 23-27 | Early Evening Sessions
Select choices from Week 1, 2, 3 options below

B) U15 Bantam Sessions | 13-14 year old
Week 1 August 9-13 | Evening Sessions
Week 2 August 16-20 | Afternoon-Evening Sessions
Week 3 August 23-27 | Early Evening Sessions
Select choices from Week 1, 2, 3 options below

C) U16 Midget Sessions | 15 year old
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select choices from Week 1, 2, 3, 4 options below

D) U18 Midget Sessions | 16-17 year old
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select choices from Week 1, 2, 3, 4 options below

U13 PEEWEE PROGRAMS

Please enrol me
for this package

Week 3A
SOLD OUT

Week 2A-2B-3B
Spots Available

A2) U13 Peewee - 2 Week Package @ $550 *** Early Bird $500 ***
Select 2 week preference combination from Week 1, 2, 3 options below

A3) U13 Peewee - 1 Week Package @ $300
Select 1 week preference from Week 1, 2, 3 options below

U13 PEEWEE

2 Week Package
Select 1 Box

Week 3A
SOLD OUT

U13 PEEWEE

1 Week Package
Select 1 Box

Week 3A
SOLD OUT

A3.3) U13 Peewee - 1 Week
Week 3A August 23-27 | Early Evening Sessions
Monday-Friday 16:45-18:00 | Kinsmen B

Total Payment $

Fee as per selected rate checkbox above

U15 BANTAM
PROGRAMS

Please enrol me
for this package

Limited Spots

Week 1-2A-3A
SOLD OUT

B1) U15 Bantam - 3 Week Package @ $700 *** Early Bird $650 ***
Week 1 August 9-13 | Evening Sessions
Week 2 August 16-20 | Afternoon-Evening Sessions
Week 3 August 23-27 | Early Evening Sessions
Select 3 week preference combination from Week 1, 2, 3 options below

B2) U15 Bantam - 2 Week Package @ $550 *** Early Bird $500 ***
Select 2 week preference combination from Week 1, 2, 3 options below

B3) U15 Bantam - 1 Week Package @ $300
Select 1 week preference from Week 1, 2, 3 options below

U15 BANTAM
3 Week Package

Select 1 Box

Week 1
Week 2A-2B
Week 3A-3B
SOLD OUT

U15 BANTAM
2 Week Package

Select 1 Box

Limited Spots
Remaining

Week 1
Week 2A-3A
SOLD OUT

U15 BANTAM
1 Week Package

Select 1 Box

Limited Spots
Remaining

Week 1
Week 2A-3A
SOLD OUT

B3.4) U15 Bantam - 1 Week
Week 3A August 23-27 | Early Evening Sessions *** Option 3A ***
Monday-Friday 18:15-19:45 | Kinsmen B

Total Payment $

Fee as per selected rate checkbox above

U16 MIDGET
PROGRAMS

Please enrol me
for this package

Week 3B
Week 4A-4B
SOLD OUT

C1) U16 Midget - 3 Week Package @ $700 *** Early Bird $650 ***
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 1, 2, 3, 4 options below

C2) U16 Midget - 2 Week Package @ $550 *** Early Bird $500 ***
Select 2 week preference combination from Week 1, 2, 3, 4 options below

C3) U16 Midget - 1 Week Package @ $300
Select 1 week preference from Week 1, 2, 3, 4 options below

U16 MIDGET
3 Week Package
Combinations

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

C1.1) Week 1-2-3 Packages
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Select 3 week preference combination from Week 1, 2, 3 options below

C1.2) Week 1-2-4 Packages
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 1, 2, 4 options below

C1.3) Week 1-3-4 Packages
Week 1 August 9-13 | Late Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 1, 3, 4 options below

C1.4) Week 2A-3-4 Packages
Week 2A August 16-20 | Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 2, 3, 4 options below

C1.5) Week 2B-3-4 Packages
Week 2B August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 2, 3, 4 options below

U16 MIDGET
3 Week Package
Week 1-2-3

Select 1 Box

Week 3A-3B
SOLD OUT

C1.1.1) Week 1-2A-3A Package
Week 1 August 9-13 | Late Evening Sessions
Monday 21:00-22:15 | Meadows West
Tuesday-Friday 20:45-22:00 | Meadows West
Week 2A August 16-20 | Late Evening Sessions *** Option 2A ***
Monday-Wednesday 21:30-23:00 | Downtown
Thursday 20:00-21:30 | Downtown
Friday 20:45-22:15 | Meadows East
Week 3A August 23-27 | Evening Sessions *** Option 3A ***
Monday-Friday 20:00-21:15 | Kinsmen B

U16 MIDGET
3 Week Package
Week 1-2-4

Select 1 Box

Week 4A-4B
SOLD OUT

U16 MIDGET
3 Week Package
Week 1-3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

U16 MIDGET
3 Week Package
Week 2A-3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

U16 MIDGET
3 Week Package
Week 2B-3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

U16 MIDGET
2 Week Package
Combinations

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

C2.1) Week 1 & 2 Package
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Select 2 week preference combination from Week 1 & 2 options below

C2.2) Week 1 & 3 Package
Week 1 August 9-13 | Late Evening Sessions
Week 3 August 23-27 | Evening Sessions
Select 2 week preference combination from Week 1 & 3 options below

C2.3) Week 1 & 4 Package
Week 1 August 9-13 | Late Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 2 week preference combination from Week 1 & 4 options below

C2.4) Week 2 & 3 Package
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Select 2 week preference combination from Week 2 & 3 options below

C2.5) Week 2 & 4 Package
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 2 week preference combination from Week 2 & 4 options below

C2.6) Week 3 & 4 Package
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 2 week preference combination from Week 3 & 4 options below

U16 MIDGET
2 Week Package
Week 1-2

Select 1 Box

U16 MIDGET
2 Week Package
Week 1-3

Select 1 Box

Week 3A-3B
SOLD OUT

C2.2.1) Week 1 & 3A Package
Week 1 August 9-13 | Late Evening Sessions
Monday 21:00-22:15 | Meadows West
Tuesday-Friday 20:45-22:00 | Meadows West
Week 3A August 23-27 | Evening Sessions *** Option 3A ***
Monday-Friday 20:00-21:15 | Kinsmen B

U16 MIDGET
2 Week Package
Week 1-4

Select 1 Box

Week 4A-4B
SOLD OUT

U16 MIDGET
2 Week Package
Week 2-3

Select 1 Box

Week 3A-3B
SOLD OUT

C2.4.1) Week 2A & 3A Package
Week 2A August 16-20 | Late Evening Sessions *** Option 2A ***
Monday-Wednesday 21:30-23:00 | Downtown
Thursday 20:00-21:30 | Downtown
Friday 20:45-22:15 | Meadows East
Week 3A August 23-27 | Evening Sessions *** Option 3A ***
Monday-Friday 20:00-21:15 | Kinsmen B

U16 MIDGET
2 Week Package
Week 2-4

Select 1 Box

Week 4A-4B
SOLD OUT

U16 MIDGET
2 Week Package
Week 3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

C2.6.1) Week 3A & 4A Package
Week 3A August 23-27 | Evening Sessions *** Option 3A ***
Monday-Friday 20:00-21:15 | Kinsmen B
Week 4A August 30-September 3 | Afternoon-Evening Sessions *** Option 4A ***
Monday 19:45-21:15 | Kinsmen A
Tuesday 16:00-17:30 | Kinsmen A
Wednesday 18:00-19:30 | Terwillegar C
Thursday 17:30-19:00 | Terwillegar D
Friday 18:15-19:45 | Terwillegar D

C2.6.2) Week 3A & 4B Package
Week 3A August 23-27 | Evening Sessions *** Option 3A ***
Monday-Friday 20:00-21:15 | Kinsmen B
Week 4B August 30-September 3 | Early-Late Evening Sessions *** Option 4B ***
Monday 21:30-23:00 | Kinsmen A
Tuesday 17:45-19:15 | Kinsmen A
Wednesday 19:45-21:15 | Terwillegar C
Thursday 19:15-20:45 | Terwillegar D
Friday 19:45-21:15 | Terwillegar D

U16 MIDGET
1 Week Package

Select 1 Box

Week 3B
Week 4A-4B
SOLD OUT

C3.1) Week 1 Package
Week 1 August 9-13 | Late Evening Sessions
Monday 21:00-22:15 | Meadows West
Tuesday-Friday 20:45-22:00 | Meadows West

C3.2) Week 2A Package
Week 2A August 16-20 | Late Evening Sessions *** Option 2A ***
Monday-Wednesday 21:30-23:00 | Downtown
Thursday 20:00-21:30 | Downtown
Friday 20:45-22:15 | Meadows East

C3.4) Week 3A Package
Week 3A August 23-27 | Evening Sessions *** Option 3A ***
Monday-Friday 20:00-21:15 | Kinsmen B

Total Payment $

Fee as per selected rate checkbox above

U18 MIDGET
PROGRAMS

Please enrol me
for this package

Week 3A-3B
Week 4A-4B
SOLD OUT

D1) U18 Midget - 3 Week Package @ $700 *** Early Bird $650 ***
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 1, 2, 3, 4 options below

D2) U18 Midget - 2 Week Package @ $550 *** Early Bird $500 ***
Select 2 week preference combination from Week 1, 2, 3, 4 options below

D3) U18 Midget - 1 Week Package @ $300
Select 1 week preference from Week 1, 2, 3, 4 options below

U18 MIDGET
3 Week Package
Combinations

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

D1.1) Week 1-2-3 Packages
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Select 3 week preference combination from Week 1, 2, 3 options below

D1.2) Week 1-2-4 Packages
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 1, 2, 4 options below

D1.3) Week 1-3-4 Packages
Week 1 August 9-13 | Late Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 1, 3, 4 options below

D1.4) Week 2A-3-4 Packages
Week 2A August 16-20 | Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 2, 3, 4 options below

D1.5) Week 2B-3-4 Packages
Week 2B August 16-20 | Evening Sessions
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 3 week preference combination from Week 2, 3, 4 options below

U18 MIDGET
3 Week Package
Week 1-2-3

Select 1 Box

Week 3A-3B
SOLD OUT

D1.1.1) Week 1-2A-3A Package
Week 1 August 9-13 | Late Evening Sessions
Monday 21:00-22:15 | Meadows West
Tuesday-Friday 20:45-22:00 | Meadows West
Week 2A August 16-20 | Late Evening Sessions *** Option 2A ***
Monday-Wednesday 21:30-23:00 | Downtown
Thursday 20:00-21:30 | Downtown
Friday 20:45-22:15 | Meadows East
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B

U18 MIDGET
3 Week Package
Week 1-2-4

Select 1 Box

Week 4A-4B
SOLD OUT

U18 MIDGET
3 Week Package
Week 1-3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

U18 MIDGET
3 Week Package
Week 2A-3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

U18 MIDGET
3 Week Package
Week 2B-3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

U18 MIDGET
2 Week Package
Combinations

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

D2.1) Week 1 & 2 Package
Week 1 August 9-13 | Late Evening Sessions
Week 2 August 16-20 | Afternoon & Evening Sessions
Select 2 week preference combination from Week 1 & 2 options below

D2.2) Week 1 & 3 Package
Week 1 August 9-13 | Late Evening Sessions
Week 3 August 23-27 | Evening Sessions
Select 2 week preference combination from Week 1 & 3 options below

D2.3) Week 1 & 4 Package
Week 1 August 9-13 | Late Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 2 week preference combination from Week 1 & 4 options below

D2.4) Week 2 & 3 Package
Week 2 August 16-20 | Afternoon & Evening Sessions
Week 3 August 23-27 | Evening Sessions
Select 2 week preference combination from Week 2 & 3 options below

D2.5) Week 2 & 4 Package
Week 2 August 16-20 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 2 week preference combination from Week 2 & 4 options below

D2.6) Week 3 & 4 Package
Week 3 August 23-27 | Evening Sessions
Week 4 August 30-September 3 | Evening Sessions
Select 2 week preference combination from Week 3 & 4 options below

U18 MIDGET
2 Week Package
Week 1-2

Select 1 Box

U18 MIDGET
2 Week Package
Week 1-3

Select 1 Box

Week 3A-3B
SOLD OUT

D2.2.1) Week 1 & 3A Package
Week 1 August 9-13 | Late Evening Sessions
Monday 21:00-22:15 | Meadows West
Tuesday-Friday 20:45-22:00 | Meadows West
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B

U18 MIDGET
2 Week Package
Week 1-4

Select 1 Box

Week 4A-4B
SOLD OUT

U18 MIDGET
2 Week Package
Week 2-3

Select 1 Box

Week 3A-3B
SOLD OUT

D2.4.1) Week 2A & 3A Package
Week 2A August 16-20 | Late Evening Sessions *** Option 2A ***
Monday-Wednesday 21:30-23:00 | Downtown
Thursday 20:00-21:30 | Downtown
Friday 20:45-22:15 | Meadows East
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B

U18 MIDGET
2 Week Package
Week 2-4

Select 1 Box

Week 4A-4B
SOLD OUT

U18 MIDGET
2 Week Package
Week 3-4

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

D2.6.1) Week 3A & 4A Package
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B
Week 4A August 30-September 3 | Afternoon-Evening Sessions *** Option 4A ***
Monday 19:45-21:15 | Kinsmen A
Tuesday 16:00-17:30 | Kinsmen A
Wednesday 18:00-19:30 | Terwillegar C
Thursday 17:30-19:00 | Terwillegar D
Friday 18:15-19:45 | Terwillegar D

D2.6.2) Week 3A & 4B Package
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B
Week 4B August 30-September 3 | Early-Late Evening Sessions *** Option 4B ***
Monday 21:30-23:00 | Kinsmen A
Tuesday 17:45-19:15 | Kinsmen A
Wednesday 19:45-21:15 | Terwillegar C
Thursday 19:15-20:45 | Terwillegar D
Friday 20:00-21:30 | Terwillegar D

D2.6.3) Week 3A & 4C Package
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B
Week 4C August 30-September 3 | Late Evening Sessions *** Option 4C ***
Monday 21:00-22:30 | Kinsmen B
Tuesday 20:30-22:00 | Kinsmen B
Wednesday 21:30-23:00 | Terwillegar C
Thursday 21:00-22:30 | Terwillegar D
Friday 20:00-21:30 | Terwillegar B<

U18 MIDGET
1 Week Package

Select 1 Box

Week 3A-3B
Week 4A-4B
SOLD OUT

D3.1) Week 1 Package
Week 1 August 9-13 | Late Evening Sessions
Monday 21:00-22:15 | Meadows West
Tuesday-Friday 20:45-22:00 | Meadows West

D3.2) Week 2A Package
Week 2A August 16-20 | Late Evening Sessions *** Option 2A ***
Monday-Wednesday 21:30-23:00 | Downtown
Thursday 20:00-21:30 | Downtown
Friday 20:45-22:15 | Meadows East

D3.4) Week 3A Package
Week 3A August 23-27 | Late Evening Sessions *** Option 3A ***
Monday-Friday 21:30-23:00 | Kinsmen B

Total Payment $

Fee as per selected rate checkbox above

Select Payment Method *

Cheque payable to: South Side Athletic Club
4250 – 91A Street NW, Edmonton, AB T6E 5V2
* Booking to be confirmed upon receipt of cheque within 7 days

Or send E-transfer request to: registrar@ssac.hockey

Credit Card Online
Debit Card Online (MasterCard/Visa affiliation only)
* Select checkbox, then fill out credit/debit form below to submit payment

Final Payment $

Fee as per selected rate checkbox above

Credit Card - First Name *

First Name - Capital first letter Title Case, e.g. John

Credit Card - Last Name *

Last Name - Capital first letter Title Case, e.g. McDonald

Credit Card *

Card Number | Expiry Date | CVC | MasterCard – Visa – AMEX

Parent / Guardian Name *

First Last

Emergency Phone Number *

000-000-0000

Player Health Care Number *

12345-6789

Medical Doctor Name *

First Last

Medical Doctor Phone Number *

000-000-0000

Medical Alert / Allergies

State any Medical Conditions

Player / Parent Acknowledgement *

The player / parent / guardian acknowledges and agrees that the South Side Athletic Club Summer Camp, its members and administrators will not be held responsible for any accident or loss. And furthermore, agree to release the SSAC Summer Camp and its members from all claims or damages which may arise as a result of or by reason of such accidents or loss. The administration reserves the right to remove any participant who, in our opinion, is not acting in an acceptable manner.

Comments / Enquiries

For additional requests or questions. Or contact us before submitting form: info@ssac.hockey