2022-2023 BLOMHA REP MD Spring Tryout Registration (BLOMHA)
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2022-2023 BLOMHA REP MD Spring Tryout Registration
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2022-2023 BLOMHA REP MD Spring Tryout Registration
Player Information
Please fill out accordingly.
Last Name
*
First Name
*
Date of Birth
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
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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
*
Select One...
House League
House League Select
Rep AAA
Rep AA
Rep A
MD
Did not play hockey
Association played with for 2021-2022 season
*
Select One...
BLOMHA
Jr Raiders
Eagles
Other
Did not play hockey
Hockey History for 2020-2021
*
Select One...
House League
House League Select
Rep AAA
Rep AA
Rep A
MD
Did not play hockey
Association played with for 2020-2021 season
*
Select One...
BLOMHA
Jr Raiders
Eagles
Other
Did not play hockey
Hockey History for 2019-2020 season
*
Select One...
House League
House League Select
Rep AAA
Rep AA
Rep A
MD
Did not play hockey
Association played with for 2019-2020 season
*
Select One...
BLOMHA
Jr Raiders
Eagles
Other
Did not play hockey
Player Division + Position
Tryout Division
*
Select One...
U14 (2009)
U15 (2008)
U16 (2007)
U18 (2005-2006)
Preferred position
*
Forward
Defense
Goaltender
Unsure
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
*
Select One...
U14 -- $75.00
U15 -- $75.00
U16 -- $75.00
U18 -- $75.00
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again