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Perth Blue Wings
Youth Hockey Skills Registration (ages 13 - 17)
August 26 - 28, 2024, 6-8pm
One form per player
Cost is $150, includes HST
Payment can be sent to
payment.pbw@gmail.com
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* Indicates required question
Players name (first and last)
*
Your answer
Players date of birth
*
MM
/
DD
/
YYYY
Parent/Guardian Contact (first and last name)
*
Your answer
Parent/Guardian phone number
*
Your answer
Parent/Guardian Email Address
*
Your answer
Level playing in September 2024 and position (ie U10 forward)
*
Your answer
If you would like a personalized jersey please select below. An additional charge of $30 must be added to the registration fee. All jerseys are Adult XL.
Yes, I would like to order a jersey for an additional $30.00
Clear selection
Name and number for personalized jersey
Your answer
Any food allergies or medical restrictions
Your answer
The applicant will not hold the owners and staff of the Perth Blue Wings Hockey Club liable/responsible for damages, loss or injury which may occur and hereby release the Perth Blue Wings Hockey Club from any actions which may occur while attending the PBW Youth Hockey Camp. This release covers travel to and from the arena as well as any and all activities on and off the ice.
*
I have read and acknowledged the above waiver
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