Notice: JavaScript is required for this content. Please fill out this form as completely as you can. The Registrar will contact you when there is a spot to register your child. Please be patient and know that PMHA works hard to find a spot for every player while being mindful of team size limits. (* = required) WAIT LISTED PLAYER / APPLICANT Player's First Name* Last Name* Gender* ---FemaleMaleOther Address* City (Postal)* Province* British ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNew BrunswickPrince Edward IslandNova ScotiaNewfoundland and LabradorYukonNorthwest TerritoriesNunavut Postal Code* Phone Number* Cell Number Email Address* PRIMARY CONTACTS Parent or Guardian's First Name* Last Name* Phone Number (If different from above.) Emergency Contact First Name* Last Name* Emergency Contact Phone Number* PLAYER DETAILS Player's Birth Date* Player's Birth Certificate ID Number* (YYYY########): Player's Health Card Number* Select the Division Based on Birth Year* ---Initiation (2012 - 2013)Novice (2010 - 2011)Atom (2008 - 2009)PeeWee (2006 - 2007)Bantam (2004 - 2005)Midget (2001 - 2003) Does this player intend to try out for a Representative team?* ---YesNo If the player is female, does she wish to play on a female-only team? YesNo If "Yes", would she play on an integrated, mixed team there are insufficient numbers to form a female team? YesNo Preferred Position* ---DefenseForwardGoalieUnknown Has your child ever played hockey before?* ---No hockey experience.Yes, with Peninsula Minor Hockey.Yes, with another association but they are full.Yes, with another association, but we have moved to the PMHA catchment area.Yes, but not with a minor hockey association.