Michigan Burn Tryout Registration Form

Michigan Burn Tryout Registration Form

Please complete all fields to register for the 2026-2027 season. For more information contact Joe Gallagher at 586-876-0109 or joegall8@hotmail.com.
Parent or Guardian Name

First NameLast Name
Player's Name

First NameLast Name
Player's Age
Player's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Player's Gender
Current Club
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Email
example@example.com
Comments
Should be Empty: