2024 YOUTH REGISTRATION - KW Roller Hockey

Form

Player Email

Player Name

Address

Street Address

City

Country

Player Birth Date

If any allergies or health problems please describe below

Parent/Guardian name

Parent/Guardian Email

Parent/Guardian Phone !

Emergency Contact Phone (other than listed above)

Emergency Contact Name (other than listed above)

LEVEL OF ICE HOCKEY LAST PLAYED

AAA AA A HOUSE LEAGUE

Additional Info

Click here to read waiver (opens in a new window, make sure popup blockers are disabled)

Accept Waiver

I have read and fully understood the Kitchener Waterloo waiver Form

Signature

Full Name

Sign

Payment

Price$349.99

PLAYER REQUEST

CouponApply

Discount

Subtotal

Tax

Total CAD