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Haliburton Hockey Haven

Single Registration Form

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First Name: *

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Last Name: *

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Address: *

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Suite / Unit:

City / Town: *

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Province / State *

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Country: *

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Postal / Zip: *

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Telephone: *

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Email: *

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Fax:

Childs Name: *

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Childs Age: *

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Emergency Contact: *

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Emergency Phone #: *

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Health Card #: *

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Choose Week: *

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*** GIRLS ONLY - WEEK #2

*** TEAM WEEK - WEEK #8

Comments:

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I Like Hockey Haven Because...

	I Love Hockey!
	The Friends Are Great!
	Play With A Professional!
	Hockey Is Life...