High Performance Training Program Registration
Team
Please Select
U18 (03,04)
U16 (05)
U15 (06)
U14 (07)
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Position
Please Select
Forward
Defense
Goalie
Shoots
Please Select
Left
Right
Current Team and Level
Healthcare Number
Medical Conditions or Allergies
Mother's Name
Father's Name
Parent Contact Phone Number
Please enter a valid phone number.
Parent Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment
*
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High Performance Training Teams Registration
$
90.00
CAD
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Submit
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