Registration – old – Xcelerate Hockey

Registration – old

Player Registration

fields marked with an asterisk (*) are required.

Name:*

First

Last

Address:*

Street Address City Province Postal

Date of Birth:*

day

month

year

Gender:*

Female

Male

Email:*

Contact Phone #1:*

Area Code

Phone Number

Contact Phone #2:*

Area Code

Phone Number

Business Phone:

Area Code

Phone Number

2021-2022 Team Association:*

Select Player Position:*

Select Program Requested:*

Select Week Requested:*

Medical Information:*

Parent Name*

First

Last

P.O.Box 502
Belmont, ON
N0L 1B0

519-644-1846