Dollard Hockey- Tiny Tots Registration

Dollard Hockey- Tiny Tots Registration
Date of Registration*

MonthDayYear
Date
Child Name:*

First NameLast Name
Date Of Birth*

MonthDayYear
Date of Birth
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*
Please enter a valid phone number.
E-mail Address*
example@example.com
Medicare Card # *
Medicare Card# Expiry Date*

MonthDayYear
Date
Please Only Choose one of the sessions below.
Saturday/Samedi January 11- March 15 9:30 – 10:30
Saturday/Samedi January 11- March 15 10:30 – 11:30
Sunday/Dimanche January 12- March 16 3:30-4:30
Level Of Experience (skating)*
IMPORTANT NOTICE - READ CAREFULLY

I/We, the parents or guardians of the above named candidate, hereby give my/our approval to his/her participation in any TINY TOTS activities. We assume all risks and hazards to each participation including transportation to and from the activities including on and off-ice. We do hereby release and waive all responsibility to the TINY TOTS program and all affiliates in regards to any injuries to the participant whether the results of negligence or any other cause.
Parent Name*

First NameLast Name
Parent Signature*

Clear

My Products

Tiny Tots RegistrationRegistration Fee for Tiny Tots Summer Edition

$130.00CAD Quantity
Item subtotal:$0.00CAD

Total

$0.00CAD

Credit Card

Apple Pay

Google Pay

Please Only Choose one of the sessions below.