Takapuna Hockey Club Youth Registration
Email address *
Name *
Your answer
Gender *
Date of Birth *
(change the year from 2019)
MM
/
DD
/
YYYY
Phone Number *
Your mobile phone number or other contact phone number
Your answer
Address *
Your home address
Your answer
School *
Name of the school that you attend
Your answer
Current Team/Rep team you play for *
Leave blank if you do not currently play for a team
Your answer
If you played youth hockey last year, which club/team did you play for?
Leave blank if you did not play youth hockey last year
Your answer
What is your preferred position?
You may check more than one box
Left
Center
Right
Goalkeeper
Back
Half
Inside
Forward/Striker
Preferred team mates
List up to 4 friends that you would like to play in the same team as
Your answer
Emergency Contact *
Name and Contact Number
Your answer
Medical Conditions
Please provide details of any medical condition we should be aware of (leave blank if none)
Your answer
Submit
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