2024 YOUTH REGISTRATION

Form

Fields marked with an * are required.

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Player Email

Player Name

Address

Street Address

City

Country

Player Birth Date

If any allergies or health problems please describe below

PARENT/GUARDIAN INFO

Parent/Guardian name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone !

emergency contact

Emergency Contact Phone (other than listed above)

Emergency Contact Name (other than listed above)

First Name

Last Name

VOLUNTEER

PLAYER EXPERIENCE

LEVEL OF ICE HOCKEY LAST PLAYED

AAA AA A HOUSE LEAGUE

player position

ADDITIONAL INFO

Additional Info

payment & waiver

Click here to read waiver (opens in a new window, make sure popup blockers are disabled)

Accept Waiver

I have read and fully understood the Kitchener Waterloo waiver Form

Signature

Full Name

Sign

Payment

Price$349.99

PLAYER REQUEST

Payment

CouponApply

Discount

Subtotal

Tax

Total CAD

PARENT/GUARDIAN INFO

emergency contact

VOLUNTEER

PLAYER EXPERIENCE

player position

ADDITIONAL INFO

payment & waiver

Payment

The form has been submitted.