HSRegistration

High school hockey
summer development registration

* Indicates required field

Player Name *

First

Last

DOB (mm/dd/yyyy) *

2014-2015 Level of Play *

Position(s) *

Address *

City *

State *

Zip *

Parent #1 Name *

Parent #1 Email Address *

Parent #2 Name *

Parent #2 Email Address *

Parent #1 Phone (H) *

Parent #1 Phone (C) *

Parent #2 Phone (H) *

Parent #2 Phone (C) *

Payment Type *

Check by Mail Credit Card

Select Credit Card *

Visa MasterCard

Credit Card Number *

Expiration Date (mm/yy) *

Name on Credit Card *

Okay to Charge $377.77 (includes 3.5% surcharge) *

Yes No

Comment *

Submit