Group Registration

Group Registration

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Haliburton Hockey Haven

Group 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:

*** Please Call if your quantity of registrants exceeds 7 children ***

#1 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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#2 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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#3 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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#4 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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#5 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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#6 Childs Name:

Childs Age:

Emergency Contact:

Emergency Phone #:

Health Card #:

#7 Childs Name:

Childs Age:

Emergency Contact:

Emergency Phone #:

Health Card #:

Choose Week: *

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*** GIRLS ONLY - WEEK #2

*** TEAM WEEK - WEEK #8

Comments:

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