Triple Play Indoor Hockey Registration Form
Club Members: $ 10.00
Non- members: $20.00
(Includes team shirt)
Name: _________________________________________________________
Age: ______________
Parent’s Name: __________________________________________________
Address: _______________________________________________________
Home Phone: _______________________________________________
Emergency Contact Number: ___________________________
_____: Volunteers Needed Please check here if you would like to coach.
Amount paid: ______________________
I give my child permission to attend the Boys & Girls Club Intramural Sports program and to obtain emergency medical attention if necessary.
MUST BE SIGNED BY PARNET/GUARDIAN IF CHILD IS UNDER 18 YEARS OF AGE.
Parent/Guardian Signature: __________________________________________
Date: _________________________
