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Remember to TAB between fields, do not press ENTER!

Please review the LIT Program Outline before completing this form.

First & Last Name Sex  MF Age at CampBirthdate 
Home Address  
City/Town Prov/State Postal/Zip CodeTelephone 
 LIT's e-mail address   Parent's e-mail address 

												
						

												
						
	Camper Week(s) Information

How many summers have you attended H.O.C.?   Hockey Position 
							
							
							

							
							
							
							
							
							Forward/Defence  							
							
							
							
							Goaltender

						
						
						
Camper Week  
							
							
							

							
							
							Week One July 4 - July 10				
							
							Week Two July 11 - July 17  							
							
							Week Three July 18 - July 24  							
							
							Week Four July 25 - July 31  							
							
							Week Five August 1 - August 7  							
							
							Week Six August 8 - August 14  							
							
							Week Seven August 15 - August 21 							
							
							Week Eight August 22 - August 28 						
						
						   If you wish to attend Senior Camp for more than one week, add dates here 
Camper Program  
							
							
							

							
							
							Resident Hockey

							
							
							Resident Camp Only

							
							
							Ice Only Program

						
						
						
Hockey Background
Current Level of Play     Height    Weight   Association Playing For   
Please group me with in the cabins.

													
						

																		
						
L.I.T. Program Information

Education:  Secondary School   Current Grade 

Note: Reference will be emailed a web link to complete references emial address is required.
References (outside family, preferably teacher, employer, and or athletic coach)
Name   Relationship to You  Telephone   Email 

Name   Relationship to You  Telephone   Email 



Session Dates:  I am interested in attending (List first choice, as well as second choice)
First Choice       
							
							
							

							
							
							
							Session One, Week #2 (SR. Camper) & Week #3 (LIT) July 11- 24  							
							
							Session Two, Week #3 (SR. Camper) & Week #4 (LIT) July 18 - July 31 							
							Session Three, Week #6(SR. Camper) & Week #7 (LIT) August 8 - 21
							
							
							
							Session Four, Week #7 (SR. Camper) & Week #8 (LIT) August 15 - 28 						
						
						
Second Choice  
							
							
							Session One, Week #2 (SR. Camper) & Week #3 (LIT) July 11 - 24
							
							Session Two, Week #3 (SR. Camper) & Week #4 (LIT) July 18 - 31
							
							
							
							
							Session Three, Week #6  (SR. Camper) & Week #7 (LIT) Aug 8 - 21
							Session Four, Week #7 (SR. Camper) & Week #8 (LIT) Aug. 15 - 28
						
						
						
												
						

												
												
Please identify all extracurricular activities (athletic teams, clubs, student council, social organizations, etc.) and your role within the activity (team captain, president, committee member,etc.).

Years	Extracurricular Activity	Role Within Activity

Please identify all volunteer work (coaching, mentoring, teaching, etc.)

Years	Volunteer Organization	Volunteer Position

Please explain your personal experience as a camper (and name of camps attended) and your interest in working within the camp community (200 words or less)

Given the program outline, what would you like to achieve by attending our LIT program? (100 words or less)