2022-2023 BLOMHA REP MD Spring Tryout Registration (BLOMHA)

Print 2022-2023 BLOMHA REP MD Spring Tryout Registration

Player Information

Please fill out accordingly.

Last Name^*
First Name^*

Date of Birth ^*

Open the calendar popup.

Email Address (primary contact for tryouts)^*

Example: [email protected] Your submission will be sent to this address.
Street Address^*
City^*

ONLY Burlington Residents Eligible
Postal Code^*
Telephone^*

Example: ###-###-####
Alternate Telephone (if applicable)

Example: ###-###-####
Year moved into above address^*

PLEASE PUT IN ALL FOUR NUMBERS

Documentation

Upload Birth Certificate OR Passport. If documentation is not supplied registration will not be accepted.

Please attach a copy of either a Birth Certificate or Passport

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 1. Maximum File Size: 4MB.

Player History

Hockey History for 2021-2022^*
Association played with for 2021-2022 season ^*
Hockey History for 2020-2021^*
Association played with for 2020-2021 season ^*
Hockey History for 2019-2020 season^*
Association played with for 2019-2020 season^*

Player Division + Position

Tryout Division^*
Preferred position ^*
ForwardDefenseGoaltenderUnsure
Please click all that apply

PLEASE NOTE
- Players must bring a jersey with a number on it
- Minimum of three tryouts
- ABSOLUTELY NO REFUNDS of full or partial tryout fees
I HAVE READ AND AGREE TO THE ABOVE STATEMENTS^*
PARENT STATEMENT OF CONSENT

I acknowledge that all of the above information is correct and I understand that regardless my child's attendance I will be charged the full fees.

I HAVE READ AND AGREE TO THE ABOVE STATEMENT.^*

Payment

PayPal account is not necessary. Payment can be made using Visa or MasterCard.

Tryout Fee ^*

Human Validation

Check The Box ^*