Summer Camp Form Preview

SSAC Summer Camp 2020
First Name - Title Case, e.g. Connor
Last Name - Title Case, e.g. McDavid
000-000-0000
Contact Email Address
mm/dd/yyyy
*** Select birth year then month-day ***
e.g. 11100 - 123 Street NW
City
Province
Postal Code e.g. T6T 1E1
Complete Street Address, City, Province, Postal Code
Fee as per selected rate checkbox above
Fee as per selected rate checkbox above
Fee as per selected rate checkbox above
Fee as per selected rate checkbox above
Fee as per selected rate checkbox above
First Name - Capital first letter Title Case, e.g. John
Last Name - Capital first letter Title Case, e.g. McDonald
Credit Card Number - MasterCard / Visa / AMEX
Expiry Month
Expiry Year
CVC
First Last
000-000-0000
12345-6789
First Last
000-000-0000
State any Medical Conditions
For additional requests or questions. Or contact us before submitting form: info@ssac.hockey
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