PPD Inc Hockey Registration Form

Hockey Skills Development Registration Form
Student's First and Last Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email of Player/Athlete:
example@example.com
Any Health Concerns:
Special Needs:
Health Card Number:
Name of Parent/Guardian:

First NameLast Name
Contact Phone #:
Format: (000) 000-0000.
Email of Parent/Guardian
example@example.com
Emergency Contact:
Emergency Contact Phone #:
Format: (000) 000-0000.
T-Shirt Size:
Jersey Size:
Required only for Hockey Registration
Position:
Required only for Hockey Registration
If you are registering a Player (C/LW/RW/D) enter 1 and for Goalie enter 0.

If you are registering a Goalie enter 1 and for Player enter 0.

Once both spots show 0 remaining we will no longer accept applications for registration.

The 2 options below are required to keep track so we don't over book.
Player Registration
Goalie Registration
Parent/Guardian Signature:
Date:

MonthDayYear
Date
Player/Athlete Signature:
Date

MonthDayYear
Date

Payment Amount

CADTax Inclusive

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty: