Facey Fall Camp Registration 2011

Please complete all fields, if a field does not apply to you simply type in N/A, please follow sample formats.
Medical form is required before student is eligible to participate in contact practice.

First Name (ie. Joe):
Last Name (ie. Athlete):
Mailing Address:
City:
Province:
Postal Code (ie. T8A 2B0:
Phone number 1( ie. 7801234567):
Phone number 2:
Player Cell:
Parent/Guardian Name (Male)::
Parent/Guardian Email 1:
Parent/Guardian Name (Female):
Parent/Guardian Email 2:
Player Email:
Height in feet and inches (ie. 5'9):
Weight in pounds:
Birthdate (DD/MM/Year):
Current Grade:

Please complete attached medical form
as part of Registration process..