2017-18 Registration Form (Ingersoll & District Minor Hockey)

Print 2017-18 Registration Form
Player 1 Registration:
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
    MM/DD/YYYY
  2. Check All That Apply
  3. $75.00 for 2 - 90 Minute Skates or 3 - 60 Minute Skates Minimum
  4. Guaranteed 5 sessions for $50 (If your child is trying out for a Rep team but would be interested in this option if he/she ends up on a LL team, please send in a post dated chq for Sept. 30th for this option. It will be returned to you if your child plays on a Rep team.
Player 2 Registration:
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
    MM/DD/YYYY
  2. Check All That Apply
  3. $75.00 for 2 - 90 Minute Skates or 3 - 60 Minute Skates Minimum
  4. Guaranteed 5 sessions for $50 (If your child is trying out for a Rep team but would be interested in this option if he/she ends up on a LL team, please send in a post dated chq for Sept. 30th for this option. It will be returned to you if your child plays on a Rep team.
Player 3 Registration:
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
    MM/DD/YYYY
  2. Check All That Apply
  3. $75.00 for 2 - 90 Minute Skates or 3 - 60 Minute Skates Minimum
  4. Guaranteed 5 sessions for $50 (If your child is trying out for a Rep team but would be interested in this option if he/she ends up on a LL team, please send in a post dated chq for Sept. 30th for this option. It will be returned to you if your child plays on a Rep team.
Player 4 Registration:
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
    MM/DD/YYYY
  2. $75 2 - 90 Minute Skates or 3 - 1 Hr Skates Minimum
  3. Guaranteed 5 sessions for $50 (If your child is trying out for a Rep team but would be interested in this option if he/she ends up on a LL team, please send in a post dated chq for Sept. 30th for this option. It will be returned to you if your child plays on a Rep team.
Player's Address:
Parent 1 (or Guardian) Information:
  1. Example: ###-###-####
  2. Example: [email protected] Your submission will be sent to this address.
Parent 2 (or Guardian) Information:
  1. Example: ###-###-####
  2. Example: [email protected] Your submission will be sent to this address.
Method of Payment:
Please forward payment to: Ingersoll & District Minor Hockey Association 200 King Hiram St Ingersoll, Ontario N5C 1L8 **Please note that all first time registrants must also submit a signed Code of Conduct**
  1. Check All That Apply
  2. $200 per family dated for March 30/2015
OMHA Terms and Conditions
Permission:
Notes:
Signature:
I, the undersigned certify that the information provided is true and in consideration of the granting of this certificate to me with the privileges incident thereto and by signing this certificate I have become subject to the rules, regulations and decisions of the OMHA/OHF/Hockey Canada and its executive. I am aware that these rules and regulations are available to me through my local executive.
  1. RadDatePicker
    RadDatePicker
    Open the calendar popup.
    MM/DD/YYYY
  2. Parent/Guardian's name submitting application
Human Validation
Printed from ingersollminorhockey.ca on Sunday, August 20, 2017 at 9:42 AM