Youth Registration 2024!

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Player Name

First Name

Last Name

Address

Street Address

City

Country

Player Birth Date

If any allergies or health problems please describe below

Parent / Guardian Info

Parent / Guardian Name

First Name

Last Name

Parent / Guardian Email

Parent / Guardian Phone 1

Parent / Guardian Phone 2

Emergency Contact

Emergency Contact Name (Other than Parent / Guardian Above)

Emergency Contact Phone (Other than Parent / Guardian Above)

Volunteer

Player Experience

Level of ice hockey last played

AAA AA A House League

Player Position and Age

Team Sponsorship

Additional Info

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

Payment & Waiver

Accept Waiver

I have fully read and fully understood the Halton Roller Hockey waiver form

Signature

By writing my name into the signature box, I understand that my child will be participating in roller hockey at Halton Roller Hockey, I understand all the risks attached to the sport in which my child will participate.

Full Name

Sign

Payment

Select

Payment

CouponApply

Discount

Subtotal

Tax

Total CAD