Youth Hockey Registration - MAD Inline Hockey

MAD Inline Hockey

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Youth Roller Hockey Registration

Youth Athletes Name

Athletes DOB

Parents Name

Parents Phone

Email

Player's Phone

For Jr Prospect Program Only

Position

Goalie Player

MAD YOUTH HOCKEY

MAD Jr Prospect Program Private Lessons MAD Complete Player Clinics MAD Learn to Play

Jersey Size

Small Medium Large XL Goalie

Jersey Number

Please provide 3 numbers

Payment

Discount

Subtotal

Tax

Total USD

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High School Hockey Schedule

Players Name

High School/Club Hockey Team

High School/Club Game Dates and Times

Practice Nights

Payment

Discount

Subtotal

Tax

Total USD

The form has been submitted.

League Info

Programs

Leagues - https://www.madhockey.org/youth-roller-hockey-leagues

Clinics - https://www.madhockey.org/youth-hockey-clinics

General Questions

Name

Phone

Email

General Question

Payment

Discount

Subtotal

Tax

Total USD

The form has been submitted.

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