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2020-21 Provincial Program Registration
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* Indicates required question
Email
*
Your email
Player's Last Name
*
Your answer
Player's First Name
*
Your answer
Gender
*
Male
Female
Other:
Birthdate
*
MM
/
DD
/
YYYY
Parent #1 Name
*
Your answer
Parent #1 Phone
*
Your answer
Parent #1 Email
*
Your answer
Parent #2 Name
Your answer
Parent #2 Phone
Your answer
Parent #2 Email
Your answer
Club Registered With:
*
Choose
Central Queens Clippers SC
Eastern Eagles SC
Eliot River Ramblers SC
Kensington & Area SC
Morell Strikers SC
North Shore Sharks SC
Sherwood-Parkdale Rangers SC
Souris Lamplighters SC
Stratford SC
Summerside United SC
West Prince Storm SC
Winsloe-Charlottetown Royals FC
No club
Please indicate any medical conditions (medications, any physical limitations, allergies, etc.)
Your answer
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