Lady Patriots U-Can

Lady Patriots - U-Can - Registration Page

Please complete the information and we will add you to our information mailing list
Interested Player *

First Name Last Name
Player's DOB *

Month Day Year
USA Hockey IMR *
Mother's Name *

First Name Last Name
E-mail (Mother) *
Father's Name *

First Name Last Name
E-mail (Father) *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Cell Phone (Mother) *

Area Code Phone Number
Cell Phone (Father) *

Area Code Phone Number
Comments
Days & Times *

Tuesday's @ Hatfield, 5:10-6:10pm Fridays @ Hockey Heaven, 5:45-6:45pm
Sessions Per Week *

One Session Two Session
Payment Options *

Pay Online Pay by Check
Type a question

Open On Hold Type option 3 Type option 4
Full Tuition Payment 1 Session: $495.00
Full Tuition Payment 2 Session: $895.00

Please Make Check Payable to:

Lady Patriots Hockey
P.O. Box 2297
Warminster, PA 18974

Online Payments *

Full Payment - 1 Session per week $ 495.00

Full Payment - 2 Sessions per week $ 895.00

Subtotal $ 0.00 Shipping $ 0.00 Total $ 0.00

Lady Patriots - U-Can - Registration Page