U15 (2010) - Tryout Registration (Quinte Red Devils)

U15 (2010) - Tryout Registration

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 U15 - 2010 group will have 2 Tryout Skates for a total of $175. (After the second skate, tryout skates will by coach invitation only.) This payment will cover all remaining skates in the 7 day tryout period, and will include a QRD tryout jersey.)
4. The payment of $175 using will be made using VISA or Mastercard and is required to complete the registration process. You will be directed to the Sports Pay site after you submit this registration form. Please have your credit card information ready for when you get to the payment section of this form.

Thanks !

I agree to the terms and conditions stated above^*

I. Player Information

First Name^*

(Enter player's First Name)

Last Name^*

(Enter player's Last Name)

Date of Birth - Month / Day / Year^*

(Please use the "date picker")

Position^*

(Select a position from the list)

Shoots^*

LeftRight

(Choose "Left" or "Right")

Home Centre^*

(Enter your Home Centre)

Team Played for Last Season^*

(Enter the team played for last year)

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

Please accurately type in your email address

Street Address^*

( 123 Maple St)

City / Town^*

( enter your city / town)

Postal Code^*

( enter your postal code - A8M3D9)

II. Parent / Guardian Information

Parent / Guardian's Name^*

Please enter parent / guardian's first and last name

Parent / Guardian's Cell #^*

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

Emergency Contact Name^*

Please enter the name of an emergency contact

Relationship to Player^*

Cell Phone #^*

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

III. Payment

Please make sure that you have your credit card information ready. You will be directed to the Sport Pay site after you "submit" this form.

Please pay this amount -^*

1. I understand that registration is not complete until payment is made. (Payment of $175 using VISA or Mastercard on the Sports Pay site.)

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^*

U15 (2010) - Tryout Registration (Quinte Red Devils)

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I. Player Information

II. Parent / Guardian Information

III. Payment

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