Rage Hockey Club Application
Player Information
(1 Player Per Registration)
Player Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age
Gender
*
Please Select
Male
Female
Have you played in CCSA's Rec Program(s) Before?
*
Please Select
SLO Hockey
CCSA Hockey
Both
None
Preferred Player Position
*
Please Select
Forward
Defense
Forward/Defense
Goalie
Preferred Jersey Number
*
Alternate Jersey Number
*
Jersey Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Shirt Size (shirts may run small)
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
What Division(s) are you interested in joining? (females can play down one extra birth year, not a full division).
*
6 & Under
8 & Under
10 & Under
12 & Under
14 & Under
16 & Under
18 & Under
21 & Under
Adult Bronze/Silver (Beginner/Intermediate)
Adult Gold/Platinum (Advanced)
Adult Pro
Parent/Guardian Information
(Required if you are 18 & Under)
Primary Parent/Guardian Information
*
First Name
Last Name
Secondary Parent/Guardian Information (If Applicable)
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Email
*
example@example.com
Secondary Email (If applicable)
example@example.com
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would Be Interested In Any Of The Following?
*
Head Coach
Assistant Coach
Team Administrator (Plan Practice/Tournament Series, Times/Organize Payments, Jerseys, etc...)
Fundraising Organizer
Volunteer
Board-member
None of the above
(Other)
Experience Bio (Please provide brief bio of hockey experience and any traveling teams you may have played for.)
*
Questions/Comments
Submit
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