Coyote Cup 3 Youth Individual Registration

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Player Info

Player Name

First Name

Last Name

Players Date of Birth

If any allergies or health problems please describe below

Player Experience

Current Roller League

Level of Ice Hockey

Parent/Guardian Info

Home City

Postal Code

Secondary Email

Home Phone

Cell Phone

Emergency Phone

Additional Info

Payment & Waiver

Click here to read the waiver (it opens in a new window; make sure popup blockers are disabled)

I Accept the Waiver

I have fully read and fully understood the Canadian Roller Hockey Group waiver form

Signature

Full Name

Sign

By writing my name into the signature box, I understand that my child will participate in roller hockey at Mississauga Roller Hockey; I know all the risks attached to the sport where my child will participate.

Division

Select

Quantity

Please select the correct division based on birth year.

Payment

CouponApply

Discount

Subtotal

Tax

Total CAD