2016-17 HOCKEY SEASON PLAYER REGISTRATION
Players Name:
Player’s Birthdate:
Grade:
Parent/Guardian (1) Name:
Address:
Home phone:
Work phone:
Email Address:
Mobile phone:
Parent/Guardian (2) Name:
Address:
Home phone:
Work phone:
Email Address:
Mobile phone:
Player Skating/Hockey Experience (include any Amateur Associate play or similar organization including years played and level played):
Season
High School
Amateur Association Age Group (circle)
Division (circle)
Other
2015-2016
V, JV, MS, Dev
MT, SQ, PW, BA, 16U, B, A-, A+ , AA,
18U
AAA
2014-2015
V, JV, MS, Dev
MT, SQ, PW, BA, 16U, B, A-, A+ , AA,
18U
AAA
2013-2014
V, JV, MS, Dev
MT, SQ, PW, BA, 16U, B, A-, A+ , AA,
18U
AAA
Total number of years playing ice hockey (including last three seasons above):
Parent/Guardian (1) (Please print)
Parent/Guardian (1) Signature, Date
Parent/Guardian (2) (Please print)
Parent/Guardian (2) Signature, Date

The registration of your player must include a $100 committee fee to be paid by check
made out to the Deer Lakes Hockey Club along with this form.
Rev 8/17/16
1