Registration Application
(PLEASE COMPLETE IN FULL, IN INK)
All information on this form is strictly for the use of the league for registration purposes
Today’s Date:_________________________
Name:____________________________________________________
Address:_________________________________________________
Season: 2016
City:_____________________________________________________
Cell Phone:______________________________
Postal Code:_____________________________________________
Home Phone:____________________________
Birthdate
(DD/MMM/YY):_________________________________
Parents Name(S):_________________________________________
e-mail address: __________________________________________
Age category:
Playing Position:
8-U
10-U
goalie
12-U
player
14-U
17-U
Mens
Womens
(Circle Your Choice)
(Circle Your Choice)
____________________________________________
Player Signature (optional)
______________________________________
Parent Signature (required)
Registration Fee must accompany this form
......................................................................................................................................................................................
FOR OFFICE USE ONLY:
Parent Volunteer Information:
Registration Fee: $____________
Would you like to coach or assist in some way with a team ?
Method of Payment:
Cash: _________ Cheque: # ________
Date Payment Received: _______________
NOTE: NSF cheques will cost you $25.00
Would you like to assist with the association in some
capacity?