Registration

Name*

First Last

Address*

Street Address Address Line 2 City Province Postal Code

Email*

Parent's Name*

First Last

Telephone Number

Cell Phone Number

Birth Date*

Age*

Group*

Novice (12,11)
Atom (10,9)
Peewee (08,07)
Bantam (06,05,04)

Sex*

Male
Female

Position*

Goalie
Forward
Defence

T-Shirt Order*

Application must be received by June 1st to receive a free t-shirt.

Cost of Program

Register before May 1st and get 10% off!
$350 Players
$300 Goalies

We accept: Cheque, Money Order and E-transfer.
Please make cheque out to Micheal Ferland Hockey School
Cheques can be mailed to Box 1803 Virden MB R0M2C0
E-transfer can be sent to michealferlandhockey@hotmail.com
The password for E-transfer will be "hockey".

Hockey School Policy
In signing this application, the parent certifies that the child is in good, normal health and has no physical handicaps. The school will provide every safeguard for the health and wellness and welfare of each child, but will not be responsible for sickness or accidents. We reserve the right to use any pictures take during your child’s play at the school for advertising or instructional purposes. The applicant agrees that Micheal Ferland Hockey School will not be held responsible for any accidents or loss, however caused, and agrees to release the proprietors from all claims or damages which may arise as a result of or by reason of such accident or loss. I have read and agreed to the above conditions.

Signature of Parent/Guardian*

Date*

REGISTRATION FORM

Cost of Program