Season:

2010-2011

Player Name:

* First Name

* Last Name

Age:

*

Years of Hockey:

Years

Birthdate:

Select 01 02 03 04 05 06 07 08 09 10 11 12 * Month

Select 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 * Day

Select 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 * Year

Travel or House:

House Travel *

Division

Select Midget Mini Mite Mite Squirt Pee Wee Bantam Girls Hockey Jr Eagles Beginning Program

Last Coach:

Skated At:

Position Played:* IF GOALIE IS INDICATED, CHILD WILL PLAY AS A GOALIE

Forward Defense Goalie

Citizenship: Select USA Canada Other *

Child Address:

*Street Address

*City

Select MI AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY *State

*Zip

Father Info:

First Name

Last Name

Email * REQUIRED

Mother Info:

First Name

Last Name

Email* REQUIRED

Guardian Info:

First Name

Last Name

Email* REQUIRED

Phone Numbers:

Home Phone

Work Phone

Cell Phone

Prefered Phone:

Select Home Work Cell

Best Time to Call:

Select Morning Mid-Day Afternoon Evening

Additional Comments:

When you click the Add Registration button below, you will be asked to complete your payment online via paypal.

As a member of the USA HOCKEY CLUB OF MICHIGAN, By clicking Add Registration, I agree to abide by all rules and regulations of USA HOCKEY CLUB OF MICHIGAN, THE MICHIGAN AMATEUR HOCKEY ASSOCIATION (MAHA), LITTLE CAESARS AMATEUR HOCKEY LEAGUE (LCAHL), AND USA HOCKEY. I will be an active participant in scheduled games, practices and team function to the best of my ability. I understand that in accordance with USA HOCKEY CLUB rules, all dues and/or fees must be paid by the due date. Non-payment of any dues and/or fees will result in suspension from team participation and termination of all membership privileges. All dues and/or fees will be non-refundable.