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.