2019-20 BROCKVILLE BLAZERS REGISTRATION
PRE-REGISTRATION FOR OUR COMPETITIVE SEASON INCLUDING TRYOUTS AND HOUSE LEAGUE. ALL INTERESTED KIDS SHOULD REGISTER AND ATTEND ALL TRYOUTS.
The following form is for Registration purposes only. Payment for teams will be collected by team manager and coach.
Which Age Group will your child be registering for?
U10 Novice Girls (2010 & 2011)
U10 Novice Boys (2010 & 2011)
U12 Atom Girls (2008 & 2009)
U12 Atom Boys (2008 & 2009)
U14 Bantam Girls (2006 & 2007)
U14 Bantam Boys (2006 & 2007)
U16 Girls (2004 & 2005)
U16 Boys (2004 & 2005)
U19 Junior CYBL Boys (2003 and older)
U19 Girls (depending on if there are interested players)
Tryouts will have a mandatory $25 fee this season with each player receiving a reversible jersey for use during evaluation period and through the season. $25 fees will go towards insurance, jersey and registration.
Do Not Accept
What size reversible jersey will your child require?
youth extra large
adult extra large
Player Name (First, Middle, Last)
Player Date of Birth
Player Home Mailing Address (#, Street, City, Postal Code)
Parent Email for use during season.
Parent Contact Number
Alternative Contact Information (Emergency)
Player's Club Last Season (Transfer from outside organizations to be approved)
Brockville House League
Allergies, Medication or Medical Conditions
Has your child had previous diagnosed concussions?
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