4-ON-4 SPRING HOCKEY REGISTRATION FORM (NORFOLK MINOR HOCKEY ASSOCIATION)
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4-ON-4 SPRING HOCKEY REGISTRATION FORM
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4-ON-4 SPRING HOCKEY REGISTRATION FORM
CONTACT INFORMATION
Please complete general information to ensure all participants are properly registered for 3on3 / 4on4 Programming
GUARDIAN NAME:
*
Enter first and last name
EMERGENCY/SECONDARY CONTACT
Enter first and last name
GUARDIAN ADDRESS:
*
GUARDIAN TELEPHONE:
*
Example: ###-###-####
EMERGENCY/SECONDARY CONTACT TELEPHONE:
Example: ###-###-####
GUARDIAN EMAIL:
*
Your submission will be sent to this address
EMERGENCY/SECONDARY CONTACT EMAIL:
Example:
[email protected]
Your submission will be sent to this address.
ADDITIONAL INFORMATION:
Please enter any restrictions or relevant medical information here.
PLAYER INFORMATION
PLAYER NAME:
*
PLAYER YEAR OF BIRTH:
*
Select One...
2016 (Waitlist)
2015 (Waitlist)
2014 (Waitlist)
2013 (Waitlist)
2012 (Waitlist)
2011 (Waitlist)
2010
2009
2008
ONLY YEARS THAT ARE AVAILABLE, ARE ABLE TO BE SELECTED
PLAYER GENDER:
*
Select One...
Female
Male
X
MINOR HOCKEY ASSOCIATION:
*
NORFOLK MINOR HOCKEY (NMHA)
PORT DOVER MINOR HOCKEY (PDMHA)
SIMCOE MINOR HOCKEY (SMHA)
WATERFORD MINOR HOCKEY (WDMHA)
OTHER MINOR HOCKEY ASSOCIATION
OTHER MINOR HOCKEY ASSOCIATION:
CURRENT DIVISION:
*
Select One...
U7
U8
U9
U10
U11
U12
U13
U14
U15
U16
CURRENT POSITION
*
Goaltender
Player
Willing to try Goaltender
Check All That Apply
CURRENT PLAYING LEVEL:
*
Introductory Program (IP)
House League (HL)/Local League (LL)
Representative (REP)
A/AA/AAA
PLAYER SKILL LEVEL:
*
Select One...
Above Average Player
Average Player
Developing Player
Beginner
Select most appropriate skill level from list.
BENCH STAFF
The success of our Spring Hockey program depends on parent volunteers. We need your help, organizing half-boards, game sheets, etc.
WILLING TO ASSIST ON THE BENCH:
Bench Volunteer
Trainer
Check ALL that apply
FIRST AID/CPR TRAINING:
Yes
No
Select 'Yes' if you have a valid First Aid certificate, otherwise select 'No'.
PAYMENT
The cost of our Spring Hockey program is $150/player, $100/goaltenders. Entry to program will be confirmed upon acceptance of payment.
PLEASE SELECT METHOD OF PAYMENT:
*
E-Transfer:
[email protected]
(Enter player name in message)
Need to make payment arrangements? Email:
[email protected]
Waitlisted
$25 NSF for returned cheques
E-TRANSFER RECEIPT:
Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.
Please upload a copy of your e-transfer receipt for payment reconciliation.
I agree to the terms and conditions stated above
*
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again