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Midwest Blackbirds Fall Registration 2021
Please complete each question to be fully registered for Fall Hockey!
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WELCOME TO THE MIDWEST BLACKBIRDS!
VIEW THE FALL 2021-2022 INFORMATION BY WATCHING THE VIDEO BELOW. CLICK ON THE VIDEO NAME TO ENLARGE.
Player's First & Last Name:
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Your answer
Male or Female?
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Male
Female
Date of Birth:
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MM
/
DD
/
YYYY
Home Address:
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Your answer
Contact #1:
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Your answer
Contact #1's Cell #:
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Your answer
Contact #2's Name:
Your answer
Contact #2's Cell #:
Your answer
Fall 2021-2022 Level:
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Silver Mite (2015)
Mite (2013 & 2014)
Squirt (2011 & 2012)
Peewee (2009 & 2010)
Bantam (2007 & 2008)
USA Hockey #:
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Your answer
House or Travel?
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House
Travel
Payment Plans:
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Payment In Full (Cash/Check/CC)3% fee will be added if you choose to pay by credit card.
Visa/MC Payment Plan - FOUR Monthly Payments - 3% fee will be added if you choose to pay by credit card.
Check Payment Plan. Postdated checks according to payment schedule.(Please drop off checks to the main office before check in for Tryouts)
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