Garfield Heights Youth Hockey Boosters
PO Box 25753
Garfield Heights OH 44125
Membership Application (All Fields Required)
2016-2017 Season
Father:_________________________________
Mother:________________________________
Address:________________________________
Address:________________________________
City/Zip:________________________________
City/Zip:________________________________
Phone (H):______________________________
Phone (H):______________________________
Phone (M):______________________________
Phone (M):______________________________
Email:__________________________________
Email:__________________________________
Player:_________________________________ Birthdate:__________ Division:___________________
Player:_________________________________ Birthdate:__________ Division:___________________
$________GHYHB Membership Dues ($60 per Family)
$________Lottery Fee ($100 per Family/sell tickets to recoup)
$________GHYHB Refundable Volunteer Fee ($50 per Family)
$________Jersey/Socks, if needed ($140 jerseys, $26 socks)
$________*Mite Player Refundable Jersey Deposit, optional ($50)
$________*1stYr Mite Player Equipment Rental Fee, optional ($75)
$________Total Due GHYHB
Date Paid:__________ Amount:$__________ Cash  Check Charge 
Lottery Ticket #’s:_____________
USA Hockey Insurance
*$45 per Player, 7yrs old and over
* Free, Under 7yrs old
* Paid online at usahockey.com
* Confirmation must be submitted to GHYHB or your Team Manager before participation.