Online League Registration Form
You can submit your registration form online by applying below. Your position will not be secured until your fees have been received.
2006 League fees are $225.00 per player including taxes. For your convenience we accept Visa , American Express and personal cheques.
Players name:
Parent / Guardians Name(s):
Street Address:
City: Prov: Ontario
Postal Code: Phone:
Date of birth: Month Jan Feb March April May June July Aug Sept Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Do you have allergies / health problems? Yes No If yes, please specify:
Emergency contact information (other then above):
Name: Phone #:
Were you a member of the league in a previous year? Yes No
If yes, what level did you play at? Hub House League
Have you played ice hockey? Yes No
Level of hockey played? AAA AA A Red White Position Played? Forward Defense Goaltender
How did you hear about our league? Corbett's Sports Oakville Beaver Abbey Oaks News Oakville Today Referral Internet Poster Flyer Community Guide
Payment Option: Cheque enclosed Cheque to follow by mail Visa American Express
Card Number:_______________________________________________________
Expiry Date:_________________________
Name as shown on card:______________________________________________
The undersigned is responsible for the conduct of the player while participating in this program. The local league as well as the governing bodies shall govern the player. It is understood that the undersigned person of legal age or legal guardian shall not hold the local league or the governing bodies, their instructors, administrators, officials or the facility used liable in the event of injury or loss. The player listed above is registered under the care of the undersigned and assumes all risks through enrollment in this program with the understanding that although play is "non-contact", it consists of physical interaction capable of injury. Halton Roller Hockey DOES NOT issue refunds. I have read and I understand all items on this player's card.
Signature___________________________________________________________ Player (if at least 18 years of age) or Parent/Guardian signature
Print out your competed form and mail it to us with your payment to secure your spot!
This is not a secure online form. You must print out this form and mail or fax it to our office to submit your registartion.
Contact Us:
We can be reached be mail at: Halton Roller Hockey 1460 Lancaster Drive Oakville, Ontario L6H 2W8
We can be reached by phone or fax at: Phone: 905-849-0132 Fax: 905-849-0805 We can be reached by email at:
info@rollerhockey.net
