Iron Man Individual Youth Rgeistration

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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

Level of Ice Hockey

Home Roller League

Parent/Guardian Info

Home City

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.

Goalies please contact

Player Request

For the Iron Man tournament, teams consist of five players and a goalie. If you have a full team, contact us!

Payment

CouponApply

Discount

Subtotal

Tax

Total CAD