Registration Form 2024-2025 (Mt Brydges Minor Hockey)

Registration Form 2024-2025

Mount Brydges Cougars are conducting 'A' tryouts starting on Saturday, May 4 – Sunday May 12, 2024 for all age groups from U10-U16.

Player First Name^*

Required

Player Last Name^*

Required

Date of Birth^*

Required

Father's Name

Mother's Name

Home Address

City^*

Required

Postal Code

Home Phone Number^*

Required

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

Cell Number

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

Email Address^*

Required

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

Emergency Contact Name

Emergency Contact Number

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

Doctor's Name

Doctor's Number

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

Does player have any medical disabilities

YesNo

If "YES" to medical, please explain

Home Association^*

Required

Player's Position^*

Required

Previous Team 2023-2024^*

Required

Hockey Centre Played In

For U14 tryouts only* - is your player planning to attend the MBDAA Checking Clinic on May 8th from 7:30pm-9pm at West Middlesex Arena?

YesNo

Please make sure you complete the registration form that is separate from this form

My Player (U14-U18 ONLY) is trying out of AE Only This year^*

YesNo

Check All That Apply

I understand that by submitting the information in this form that I certify it to be true and that I have become subject to the Rules & Regulations, Constitution and Policy of MBDAA. I agree to abide by such Rules & Regulations, Constitution and Policy.^*

I agree to the terms and conditions stated above

Required

Payment for Tryout ^*

Required

Registration Form 2024-2025 (Mt Brydges Minor Hockey)

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