JULY 11 - 16, 2011

CREDIT UNION ARENA
TIGNISH, PEI

REGISTER BY JUNE 1ST, 2011 TO QUALIFY FOR FREE REGISTRATION

Participant's Name:

 __________________________________________________________________

Parent's Name:

 _____________________________________________________________________

Mailing Address:

 ____________________________________________________________________

__________________________________________________________________________________

 

Phone Number: ___________________________ Email: __________________________________

Emergency Contact:

 _________________________________________________________________

Emergency Phone Number:

 ____________________________________________________________

Health Card #:

 ______________________________________________________________________

Allergy/Medical Needs:

 _______________________________________________________________

__________________________________________________________________________________

Date of Birth:

 _______________________________________________________________________

Male __ Female __ Age __

Level played last season: __________________________ Position played:

                _____________________

PAYMENT:
INITIATION AGES 5 - 6 ($160 GST INC)
AGES 7 - 15 ($270 TOTAL GST INC)
GOAL TENDERS ~ ($130 GST INC)
FAMILY RATE - $ 50 OFF PER CHILD
MAIL TO:
TIGNISH RECREATION DEPARTMENT
209 PHILLIP ST
P.O. BOX 57
TIGNISH, PE, C0B2B0

*** Registration forms will be processed on a first come first serve basis until all spaces are filled ***