U11 & 12 (2014 & 2013) - Prep Skates (Goaltenders (Quinte Red Devils)

U11 & 12 (2014 & 2013) - Prep Skates (Goaltenders

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General Instructions:
1. Please fill out this form completely.
2. An email address is required to complete the form. It will be used for all further communication. Please ensure that it is typed in correctly.
3. The U11 and U12 age groups will be combined for the Prep Skates.
4. The U11 and U12 - (2013 & 2014) Goalies will have 4 Prep Skates. There will be no charge for goaltenders to attend the U11 & U12 Prep Skates, but we are limited to 4 goalies.

Thanks !

I agree to the terms and conditions stated above^*

Player Information

First Name^*

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(Enter player's First Name)

Last Name^*

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(Enter player's Last Name)

Date of Birth - Month / Day / Year^*

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(Please use the "date picker")

Home Centre^*

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(Enter your Home Centre)

Team Played for Last Season^*

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(Enter the team played for last year)

email address to be used for ALL acknowledgement and communications^*

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Please accurately type in your email address

Street Address^*

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( 123 Maple St)

City / Town^*

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( enter your city / town)

Postal Code^*

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( enter your postal code - A8M3D9)

Parent / Guardian Information

Parent / Guardian's Name^*

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Please enter parent / guardian's first and last name

Parent / Guardian's Cell #^*

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Example: ###-###-####

Emergency Contact Name^*

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Please enter the name of an emergency contact

Relationship to Player^*

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Cell Phone #^*

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Please read and acknowledge the following important points...

1. I understand that goaltenders are not required to pay to attend the U10 prep skates.

I agree to the terms and conditions stated above^*

2. I release QRMHA from all liability due to INJURY, ACCIDENT or LOSS of PROPERTY during the tryouts and related activities.

I agree to the terms and conditions stated above^*

U11 & 12 (2014 & 2013) - Prep Skates (Goaltenders (Quinte Red Devils)

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Player Information

Parent / Guardian Information

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