SAMH - Ste. Anne Minor Hockey

*Player's Name *Birthdate (m/d/y)

female

male

*Manitoba Health Number Players PHIN

*Father’s Name

*Address

*City/Prov

*Postal Code

*Home Phone #

*Cell #

*Email

*Mother’s Name

Address

City/Prov

Postal Code

Home Phone #

Cell #

Email

Guardian’s Name

Address

City/Prov

Postal Code

Home Phone #

Cell #

Email *Resident Municipality:

PLEASE NOTE: This form will be used to register the player initially with Ste Anne Minor Hockey Association. Registration will be final once full payment has been received. Costs for the 2011-2012 hockey season will be determined in September 2011.

In person registration will be available on August 24th and August 25th at that Arena from 6:30 to 8:30 pm. This would be for new players as a valid birth certificate is required to be presented, returning players who have not yet registered and for families wanting to select fundraising alternatives

Emergency contact Phone Number

*REQUIRED INFORMATION