Moncton Jr Vito's Tryout Registration

Moncton Jr Vito's Tryout Registration

Please fill in the form below.
Player Name*

First NameLast Name
Medicare Number
Birth Date*

MonthDayYear
Cell Phone *

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
ForwardDefenseForward or DefenseGoalie
RightLeft
What team did you play on last season?
YesNoNot sure yet
Emergency Contact*

First NameLast Name
Cellphone Number*

Area CodePhone Number
Questions or comments
Signature
I hereby allow the above named player to participate in the hockey program of the Moncton Junior Hockey Club and that he/she agrees to abide by the regulations of the Club and to play within the team rules that he/she will be assigned. I am fully aware that the Moncton Junior Hockey Club and/or the Facility will not be responsible for any injuries, loss of either time, equipment, or personal belongings of the above named player. I am also aware that I may be responsible for damages caused by the above named player to the Facility or to MJHC property or for value of unreturned MJHC and Moncton Junior Vito’s Hockey team property. By typing your name in the following box it is considered an electronic signature.
Should be Empty: