2022-23 House League SELECT Fall Tryout Form (BLOMHA)
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2022-23 House League SELECT Fall Tryout Form
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2022-23 House League SELECT Fall Tryout Form
This form is for the House League Select Fall Tryouts - U9 (2014) to U13 (2010) ONLY.
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
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...
U9 (2014)
U10 (2013)
U11 (2012)
U12 (2011)
U13 (2010)
Preferred position
*
Forward
Defense
Goaltender
Unsure
Please click all that apply
Payment
*
Select One...
Tryout Fee -- $120.00
Please complete payment upon registration.
PLEASE NOTE
Minimum of three (3) tryouts
Players must bring a jersey with a number on it (the same one for all 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.
*
Human Validation
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*
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