Vianney Hockey

New Player Registration

Name_________________________________________________________________

Address_______________________________________________________________

Telephone Numbers_____________________________________________

Birth Date:____________________

Social Security No_______________________

School & Grade _______________________________________________

Height:________ Weight_____________ Regular Shirt Size__________________

Hockey Jersey Size (Circle one): XL XXL XXXL

Number you want on your hockey Jersey:
1st Choice_____ 2nd Choice_____ 3rd Choice_____

List teams (e.g., Webster Bantam A1) you have played for and camps or clinics
attended (e.g., Turcotte 2000).

_____________________________________________________________________

Position you play _______________

Does your parent(s) have any hockey experience as player or coach?

If so, Please describe:____________________________________________

If you do not have USA Hockey Insurance, there will be a charge of $22.00

Please return this form completed form to :

xxxxxxxxxxxxxxxxxxxx