Rep Tryout Registration (Belleville Minor Hockey Association)

Print Rep Tryout Registration

Please indicate that you have taken a body checking course and that you have proof ^*
What Age Group are you Trying out for?^*
DATE OF BIRTH^*
Player Name^*
Home Centre^*
Street Address^*

Civic Address of Player (No RR or PO Boxes)
City^*
Parent's Name: ^*
What position does your player play? ^*
Please enter your email address:^*

Example: [email protected]
What is your current phone number:^*

Example: ###-###-####

Human Validation