East Alton Ice Arena

2017 Youth Spring League - Bantam/Midget

Player's First Name (no nicknames):
Player's Middle Initial:
Player's Last Name:
Parent 1 Name:
Parent 2 Name:
Birth Date: mm/dd/yyyy
Address 1:
Address 2:
City:
State:
Zip code:
Email Address:
Secondary Email Address:
Primary Phone:
Work Phone:
Cell Phone:
Waiver of Liability
I accept the Waiver of Liability terms
I further state that I will provide a statement of any disabilities, disorder or medical conditions or limitations for the above named player.
Player Background Information
Player Position:
Last Seasons Experience Level:
Division you are Signing up to Play in:
USA Hockey 2017 membership number**:
Go to: www.usahockeyregistration.com to print a copy of your 2017 membership number

** Player's without a 2017 number must first register on-line with www.usahockeyregistration.com to complete this signup.
Skater Fee $185.00
Goalie Fee $80.00
Sign me up for 4 one-Hour Session clinics for $60? Yes No