Please fill out the following form if you are planning to attend Summit Hockey Camp.

Emergency Information

In case of emergency during camp, we need a name and phone number of someone to contact. Please enter the information below.

Player Name:
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Email
Player Health Insurance Provider
Health Insurance Group ID
Health Insurance Member No.
Medical/Diet Information

Do you have any pre-existing medical conditions, injuries or severe allergies we need to be aware of? If yes, please describe below.

Do you have any dietary restrictions or food allergies we need to be aware of? If yes, please describe below.

Disclaimer & Release

By accepting these terms, I, the parent / guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of Summit Hockey Camps and its affiliated organizations and sponsors. Recognizing the possibility of physical injury, associated with ice hockey and in consideration for the Summit Hockey Camps accepting the registrant for its ice hockey programs and activities, I hereby release, discharge and/or otherwise indemnify Summit Hockey Camps, all Board members, coaches, its affiliates, organizations and sponsors, their employees and associated personnel, including the owners of the facilities used for the programs, against any claims by or on behalf of the registrants as a result of the registrant’s participation in the programs and/or transportation to or from the same, which transportation I hereby authorize. All information will be kept confidential, and I authorize that it be provided to NCAA coaches/scouts upon their request. I agree to allow photographers employed by Summit Hockey Camps to photograph the registrant during the event, and that photographs from this event may be used for marketing purposes by Summit Hockey Camps. I also give consent to Summit Hockey Camps and its medical representative to obtain medical care from any licensed physician, hospital, or clinic for the registrant, for any injury that could arise from participation in this event.

I accept these terms