Youth Team Registration 2019

Youth Team Registration

Fields marked with an * are required.

Jersey # Choice 1

1-2 digits

Last Name as it will appear on jerseys (In all CAPS)

Player's Name

First Name

Last Name

Home Address

Street Address

City

Country

Cell Phone #

Players Height

Format Example: 5-4

Players Weight (in lbs)

Format Example: 120

Jersey # Choice 2

1-2 digits

Jersey # Choice 3

1-2 digits

Name of current roller hockey club (if any)

Parent/Guardian Name

First Name

Last Name

Agree

I agree to the above waiver.

Sign your name if you agree with the above waiver

Full Name

Sign

Player Fee

Select

CouponApply

Discount

Subtotal

Tax

Total USD