Registration

Please Fill Out All Information

Name

Parent/Guardian

Street Address

Address (cont.)

City

Province

Postal Code

Country

Work Phone

Home Phone

E-mail

Home Page

Date of Birth

Sex Male Female

Sweater Size

Boys/Girls

Mens/Ladies

Previous Year

Division and Position
Physical Impairment/Medical History
All Star / Development	Yes No
Choose Your Week (s)
Week OneJuly 19 - July 23	Novice Atom Peewee Bantam
Week Two Aug 23 - Aug 27	Novice1 Novice2 Atom Peewee Bantam
Week Aug 30 - Sept 3	Novice Atom Peewee Bantam
Goaltending Program	Week One Goalie Week Two Week Three

PLEASE NOTE: Registration is limited to 30 skaters per group and will be done on a first come first served basis upon receipt of your application and deposit. To avoid disappointment register early. A $100.00 deposit must accompany an application form. Balance of payment due on registration day. There is a $50.00 non-refundable fee on all cancellations.

Name
Parent/Guardian
Street Address
Address (cont.)
City
Province
Postal Code
Country
Work Phone
Home Phone
E-mail
Home Page

Date of Birth
Sex	Male Female
Sweater Size
Boys/Girls
Mens/Ladies