#1 Student's Name *

First Name

Last Name

#2 Student's Name

First Name

Last Name

#3 Student's Name

First Name

Last Name

#4 Student's Name

First Name

Last Name

MAIN Contact's Name *

Ideally a parent or guardian

First Name

Last Name

Phone *

Ideally a parent or guardian's daytime phone number for any emergencies.

(###)

###

####

Secondary Contact Name *

First Name

Last Name

Secondary Emergency Number *

(###)

###

####

Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tell us how you heard about this event? *

Please check all that apply

Email

Flyer

Daycare

Call Hockey Program

I've attended this event before

Poster

School

A friend told me