Don Lucia Hockey Camps

Men Model Hockey Camp Registration Page

STEP 1
Fill out registration form (don't print yet!)

STEP 2
Verify registration information (don't print yet!)

STEP 3
Open and print application and medical form, sign, and mail along with registration fee

Please fill out the application below, including all required fields, and click "Submit".

If you are NOT accepted to MODEL CAMP your check will be destroyed unless you provide a self-addressed envelope.

Information

First Name *Required
Last Name *Required
Email Address *Required
Home Phone Number *Required
Cell Phone Number
Address 1 *Required
Address 2
City *Required
State/Province: *Required
Zip		*Required
Birthdate (mm/dd/yyyy) *Required
Height		*Required
Weight		*Required
Position *Required		Forward Defense Goaltender
Shoots *Required
2012-13 Team
Graduation Year *Required
Grade Point Average *Required

Personal Records

Forward & Defensive Statistics *Required
Season	Games	Goals	Assists	Points	Penalty Minutes
2012-13

Goaltending Statistics *Required
Season	Games	Minutes	Goals Against Average	Save %	Shutouts
2012-13

Varsity *Required
Junior Varsity *Required
Prep Team *Required
Junior Team *Required

Housing

Metro Applicants
I want to house outside players		No Yes Number
Player that you would like to house

Outside the Metro Applicants
Do you need housing? Please check "Yes" or "No".		No, I will take care of my own housing Yes, I need housing
If you have arranged your own housing from another player in camp please list the name of the player so we can place you on the same team.

Tuition

Tuition will be $375.00 per participant. Payment is due in full with the application. Your check will NOT be cashed until you are accepted in the school. Please make checks payable to DLJ LLC

Medical Consent

While attending the MODEL HOCKEY CAMP, I hereby consent and authorize the administration of all treatments and tests that may be considered advisable and necessary in the judgement of qualified medical personnel.
Do you have specific health problems or injuries? *Required		Yes No
If yes, please explain
Insurance Company *Required
Policy Number *Required
Each player is responsible for his own medical insurance and the information must be included to be accepted as a candidate.

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