The 2023 Black Hockey Summit Registration Form
Fill out the form carefully for registration
Player's Name
First Name
Middle Name
Last Name
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
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Day
2023
2022
2021
2020
2019
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2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
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1931
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
Please Select
Male
Female
I choose not to answer
Current Team
Playing Level
Please Select
Houseleague
Select
A
AA
AAA
Jersey Size
Please Select
Youth Small
Youth Medium
Youth Large
Youth XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Shirt Size
Please Select
Youth Small
Youth Medium
Youth Large
Youth XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Camp Options:
FULL DAY 9am-5pm
1/2 Day Mornings 9am-1pm (grassroots level only-10 and under)
1/2 Day Afternoons 12:30pm-4:30pm (grassroots level only-10 and under)
Position
Goaltender
Forward
Defense
Unsure
Are you new to hockey?
Yes, no hockey or skating experience
Yes, no hockey experience but can skate
Began a hockey program this past season
Brand new to the sport, in need of equipment and guidance on where to begin.
Do you identify as any of the following:
Black
Indigenous
Biracial
BIPOC
Person of Colour
Low income
Marginalized
Equity deserving
Are you registered with any of the following organizations
Hockey Equality
Seaside Hockey Association
Skillz Hockey
Own Hockey
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian's name
E-mail
example@example.com
Mobile Number
Does your child have any food allergies or dietary restrictions? If Yes, please list below.
Additional Comments
Please note, submission of your registration form does not guarantee your participation. We will confirm by email with a link to make your payment. Confirmation of payment of your fees confirms your attendance. Thank you.
For more information or questions, please contact Summit@hockeyequality.org
I have read the statement above and I agree or disagree.
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