Mattawa Ball Hockey Registration 2015 Held at the Mattawa Arena Name: ________________________________________ Age: ________ Allergies ___________________________Meds:__________________________ Phone Number: _______________________________Birth Date:_____________ In Case of Emergency/ Contact _______________________#_________________ E-mail:____________________________________________________________ Division: ___$65 Women’s Division------------------------------- Monday’s 7-9pm ___$125 Men’s Division---------------------------------- Tuesdays 7-9pm & Thursday 7-9pm Kid’s Divisions ------------------------------ Wednesdays ___$30 Squirts ages 4-6 ------------------------------- 4-5pm ___$40 Juniors ages 7-10 ----------------------------- 5-6pm ___$40 Intermediate ages 11-14 -------------------- 6-7pm ___$40 Seniors ages 15-18------------------------------7-8pm Please circle Shirt Size: Method of payment: S / M/ L/ xL Cash Child______ Youth________Adult_______ Cheque Signature: ____________________________________ Date: __________________ NOTICE: We do not supply Helmets or Hockey Sticks!!! Please be prepared!!! Safety First!! If you are willing to help Coach Ball Hockey this summer please sign below!!! Name:______________________________________________Number:_________________________________________ Please be advised ALL volunteers MUST have a police checks completed for this position…. Thank You!