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.
Email address *
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? *
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. *
What size reversible jersey will your child require? *
Player Name (First, Middle, Last) *
Your answer
Player Date of Birth *
MM
/
DD
/
YYYY
Player Home Mailing Address (#, Street, City, Postal Code) *
Your answer
Parent Name *
Your answer
Parent Email for use during season. *
Your answer
Parent Contact Number *
Your answer
Alternative Contact Information (Emergency) *
Your answer
Player's Club Last Season (Transfer from outside organizations to be approved) *
Allergies, Medication or Medical Conditions *
Your answer
Has your child had previous diagnosed concussions? *
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