Black Hockey Summit Registration Form

The 2023 Black Hockey Summit Registration Form

Fill out the form carefully for registration
Player's Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Current Team
Playing Level
Jersey Size
Shirt Size
Camp Options:

FULL DAY 9am-5pm1/2 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

GoaltenderForwardDefenseUnsure
Are you new to hockey?

Yes, no hockey or skating experienceYes, no hockey experience but can skateBegan a hockey program this past seasonBrand new to the sport, in need of equipment and guidance on where to begin.
Do you identify as any of the following:

BlackIndigenousBiracialBIPOCPerson of ColourLow incomeMarginalizedEquity deserving
Are you registered with any of the following organizations

Hockey EqualitySeaside Hockey AssociationSkillz HockeyOwn HockeyOther
Address

Street Address

Street Address Line 2

CityState / 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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The 2023 Black Hockey Summit Registration Form

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.