BARRIE MINOR BALL HOCKEY LEAGUE
REGISTRATION FORM
Please circle a division
MINI TYKE (04-05)
TYKE (02-03)
NOVICE (00-01)
ATOM (98-99)
PEEWEE (96-97)
BANTAM (94-95)
JUNIOR (92-93)
PLAYER INFORMATION (please print)
Last name:
First name:
Sex: M
Address:
Birthdate (M/D/Y)
City/Town:
Postal Code:
Mother:
Home#:
Cell #
Father:
Home #:
Cell #
/
F
/
Email:
GENERAL INFORMATION
My Child is a: Player
Goalie
Both
Do you wish to assist? Head Coach
Assistant Coach
Medical Conditions, if any:
Other family members registered :
ICE HOCKEY AND BALL HOCKEY HISTORY
Season
Association/League
Division
Level
SIGNATURE & WAIVER
In consideration of the Barrie Wild Minor Ball Hockey League (BMBHL) permitting the player to participate in any of the
activities of the BMBHL, I, for myself, my family, heirs, successors and executors hereby indemnify and hold harmless the
BMBHL, its directors, officers, successors and assigns, from all costs, claims, actions, damages or liabilities, whatever their nature or however caused, resulting from the participation of the player in any of the activities of the BMBHL.
There will be a $25.00 charge on all NSF cheques
PLEASE SIGN:_____________________________________________
PAYMENT:
Registration Fee: $ 125.00 (Mini- Tyke) $ 50.00
Cash
Cheque #___________ payable to Barrie Minor Ball Hockey League
Name on Cheque:
Received By:
Authorized Signature:
P.O. BOX 347, BELLE EWART, ON, L0L 1C0 TEL: 705.456.4280, [email protected]