2021/2022 BMHA Registration Form (Belmont Minor Hockey)

PARENT INFORMATION

Parent/Guardian Name(s):^*

Required

Please provide your first and last name

Full Mailing Address:^*

Required

Please provide your mailing address

Phone Number:^*

Required

Example: ###-###-####

Email Address:^*

Required

Example: [email protected]. Your submission will be sent to this address.

PLAYER 1

Player 1 First Name:

Please provide your first name only

Player 1 Last Name:

Please provide your last name only

Player 1 Birth Date:^*

Required

Player 1 Sock Size:

SM
MED
LG
XL

Check only one

Age Group:

U5 (Preschool) 2017 - $230.00
U7 (Initiation) 2015-2016 - $450.00
U9 (Novice) 2013-2014 - $580.00
U11 (Atom) 2011-2012 - $580.00
U13 (Peewee) 2009-2010 - $640.00
U15 (Bantam) 2007-2008 - $640.00
U18 (Midget) 2004-2006 - $640.00
U21 (Juvenile) 2001-2003 - $400.00

Check only one

Please attach copy of Birth Certificate (New Players to BMHA Only)

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 3. Maximum File Size: 4MB.

Please attach signed copy of Rowan's Law Acknowledgement Form^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

All Registrants on an annual basis must review the Concussion Awareness Resources and sign the Acknowledgement Form at Registration.

PLAYER 2

PLAYER 3

**THIRD CHILD DISCOUNT MUST ME YOUNGEST IN FAMILY**

PAYMENT OPTIONS

EFT payment is preferred.

Please pick payment option:^*

EFT Payment in Full by July 15, 2021
50% Cheque Postdated July 15, 2021 and 50% Cheque Postdated September 1, 2021

Check only one

Signature and Date

Parent/Guardian Signature:^*

Required

Please type your first and last name.

Date:^*

Required

2021/2022 BMHA Registration Form (Belmont Minor Hockey)

OMHA Digital Network

PARENT INFORMATION

PLAYER 1

PLAYER 2

PLAYER 3

PAYMENT OPTIONS

Signature and Date

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