4-ON-4 SPRING HOCKEY REGISTRATION FORM (2024) (NORFOLK MINOR HOCKEY ASSOCIATION)

Please complete general information to ensure all participants are properly registered for 4-on-4 Programming

GUARDIAN NAME:^*

Required

Enter first and last name

EMERGENCY/SECONDARY CONTACT

Enter first and last name

GUARDIAN ADDRESS:^*

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GUARDIAN TELEPHONE:^*

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Example: ###-###-####

EMERGENCY/SECONDARY CONTACT TELEPHONE:

Example: ###-###-####

GUARDIAN EMAIL:^*

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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.

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 VolunteerTrainer

Check ALL that apply

FIRST AID/CPR TRAINING:

YesNo

Select 'Yes' if you have a valid First Aid certificate, otherwise select 'No'.

The cost of our Spring Hockey program is $165/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

Required

$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.