Youth Registration

Fields marked with an * are required.

Player's Name

First Name

Last Name

Address

Street Address

City

Country

Date of Birth

Any allergies or health problems? If yes, please specify

Parent / Guardian Name

First Name

Last Name

Phone

EMERGENCY CONTACT NAME (OTHER THEN PARENT/GUARDIAN ABOVE)

EMERGENCY CONTACT PHONE

Accept Waiver

I agree to waiver

Accept Waiver

Full Name

Sign

Select Program

Select

Please select your child's position and age group from the drop down menu.

PLAYER REQUEST

CouponApply

Discount

Subtotal

Tax

Total CAD