Electronic Registration - Waxer Skills Clinics
Player Information (all fields required)
First Name:
Last Name:
Email:
Gender:
Male
Female
Street Address:
Town:
Postal Code:
Telephone:
OHIP Card #:
Birth date:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1995
1996
1997
1998
1999
2000
Medical Condition:
Check if this player has any physical, emotional, or medical conditions that require special attention.
If YES, Please explain:
Playing Level:
Beginner - not yet playing
House League
Select/AE
A
AA
AAA
Clinic Selections:
Fall Session - Oct - Dec
Winter Session - Jan - March
Parent/Guardian Information:
Mother's name:
Father's name
Mother Cell phone:
Father Cell phone:
Mother Work phone:
Father Work phone:
Agreement to Participate
I (enter your name)
have read, I understand and I agreed to the terms outlined in the
Markham Minor Hockey Association Participation Agreement
.