2022-23 House League SELECT Fall Tryout Form (BLOMHA)

Print 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 ^*

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

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

Payment^*

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

Check The Box ^*