Niagara Sledge Hockey League Registration

Full Name(*)

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Email(*)

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Phone

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Address(*)

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Town(*)

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Postal Code(*)

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What sessions do you plan on attending on a consistent basis? (Select all that apply)(*)

What sessions do you plan on attending on a consistent basis? (Select all that apply)

Tuesdays 6:30pm-7:30pm (Grimsby Peach King Centre)
Saturdays 3:00pm-4:30pm (Ridley College- St. Catharines)

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Disability information or other important things we should know.

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Birth Date(*)

Day01020304050607080910111213141516171819202122232425262728293031 / Month010203040506070809101112 / Year19401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Invalid Input

Parent (if under 18)

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Emergency Contact Name

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Emergency Contact Phone

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Participation Level

Participation Level

Single Game - 10.00 CAD Full Season - 150.00 CAD

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Payment Method

Payment Method

Square

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Total

0.00 CAD Invalid Input

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