NELSON MINOR HOCKEY PLAYER REGISTRATION FORM 2017/2018
PO BOX 766, NELSON, BC V1L5R4
PLAYER INFORMATION
Last Name:
First Name:
Initial:
Street Address:
City:
Postal Code:
Phone:
Email:
Gender:
BC Care Card:
Previous year division:
DOB (M/D/Y):
Applying for Kids Sport:  Yes  No
Rep Tryout  Yes
Player Position  Goalie  Defense  Forward
Fundraising is required as part of registration. If you choose not to participate in fundraising, you must include $100.00 at
the time of registration.
FUNDRAISING  YES  NO IF YES, INCLUDE $100.00 CHEQUE POSTDATED FOR DECEMBER 1, 2017
NMHA FUNDRAISING DEPOSIT FEE, cheque will NOT be cashed if you participate in NMHA fundraising activity. Activity TBD.
** If you are choosing not to fundraise, include $100.00 fee at the time of registration.
REGISTRATION FEES
DIVISION
AGE
BIRTH YEAR
CHECK APPROPRIATE BOXES 
Fill out first time registration form
* FIRST TIME PLAYER
*FIRST TIME PLAYER
Any age
$100.00
5-6
11-12
INITIATION

$250.00
6-8
09-11
NOVICE

$375.00
9-10
07-08
ATOM

$375.00
11-12
05-06
PEEWEE HOUSE

$665.00
11-12
05-06
PEEWEE REP


$375.00
13-14
03-04
BANTAM HOUSE

$665.00
13-14
03-04
BANTAM REP
$375.00
15-17
00-01-02
MIDGET HOUSE

$665.00
15-17
00-01-02
MIDGET REP

$100.00

**NOT VOLUNTEERING
Total Registration Fees = $
NO CASH PLEASE
* FIRST TIME PLAYERS PLEASE FILL OUT FIRST TIME PLAYER REGISTRATION FORM AVAILABLE ON THE NMHA WEBSITE
First time players are players that have not been registered in a minor hockey association
** If you are choosing not to fundraise, include $100.00 fee at the time of registration.
REGISTRATION NOTES:
REP REGISTRATION deadline is May 31, 2017. Late registration fees ($75.00) apply after May 31, 2017.
REGISTRATION deadline is July 31, 2017. Late registration fees ($75.00) apply after July 31, 2017. Postdated cheques
are accepted. 50% of fees are due at time of registration, remaining 50%, dated no later than November 1, 2017. All
fees must be paid in full by November 1, 2017.
3. Rep Tryout Fees ($90.00) are included in Rep fees and are not refunded if you are not assigned to a rep team.
4. $200.00 REP FEES included in rep registration. Fee will be reimbursed if you are not assigned to a rep team.
5. Registration can be mailed to the address above, or left at the front desk at the NDCC in an envelope labeled NMHA.
1.
2.
6.
7.
Rep and House Fees include league play in WKMHA
Financial support available via KIDSPORT, application deadline Aug 1, 2017. For details go to http://kidsportcanada.ca.
POST DATED VOLUNTEER CHEQUE # _______
OFFICE USE ONLY
REGISTRATION CHEQUE # _______________
DATE RECEIVED:
POST DATED CHEQUE # _________________
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NELSON MINOR HOCKEY PLAYER REGISTRATION FORM 2017/2018
PO BOX 766, NELSON, BC V1L5R4
Parent 1/ Guardian
Parent 2/ Guardian
Name:
Name:
Address (if different from player)
Address (if different from player)
Home #:
Home #:
Cell #
E-mail:
Cell #
E-mail:
Signature & Waiver:
We hereby acknowledge the authority of Hockey Canada, BC Hockey and NMHA, and agree to carry out and abide by the
constitution, bylaws, rules and regulations of those associations.
Equipment:
We, at the end of the season covered by this registration, agree to return all equipment (including jersey) provided by the
Nelson Minor Hockey Association in good condition. Should we fail to do so, we agree to pay the cost to replace the equipment
or jersey.
Release: In consideration of this application to play under the auspices of the NMHA, I do hereby for myself, heirs, executors,
administrators, and assigns, remise, release and forever discharge Hockey Canada, BC Hockey, and the NMHA, its officers, or
anyone acting on their behalf from all manner of litigation, damage claims, or demands in law or equity which I may have or
acquire by reason of personal injury to the player, loss or damage to the property, which may occur during or by reason of
participation in the activities of the association.
Privacy Clause:
NMHA does not sell, trade, or otherwise share the information we collect outside our association. However, we may from time
to time use this information for the purpose of offering additional services and promotions, including promotions offered by
third parties (ie. hockey schools). This type of usage of your personal information by NMHA is entirely at your discretion.
Media Release:
I agree to allow NMHA to use my child's team photo for use on the NMHA website or for other public relations purposes directly
relating to NMHA.
Signature of Parent/ Guardian:
Date:
Player’s Division:
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