DALE DERKATCH

Online Registration

ALL OFFENCE REGISTRATION

Please complete all sections and submit. Upon completion, print waiver form,
complete, sign, and mail in with payment.

Player's Name:
Parents' Names:
Email Address:
Street Address:
City, Prov, Postal Code:
Phone Number:
Emergency Phone Number:
Player's DOB:
Team, Level & Tier:

Sweater Size: (sweaters run big)	Jr Small/Medium
avg Atom is Jr L/XL	Jr Large/XL
avg PW is A/Sm	Adult Small
	Adult Medium
	Adult Large
ALL OFFENCE CAMP CHOICE:
	U16/U17 Invitational, July 11-14
*WAITLIST*	ATOM Summer Camp, Aug 12-16, 9-11am
WAITLIST	PW Summer Camp, Aug 12-16, 12:45-2:45pm

Comments:

*** After submitting, please print, complete and sign the
WAIVER FORM and MAIL IN with payment***