Concord Youth Hockey Association - (Concord, NH)

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Skate with The Capitals

Registration and payment must be completed "on-line" to roster a player in any of our programs and/or camps.

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

(NOTE: Players MUST be age appropriate for the practice attending.)

* Grade:

* Gender:

* Position:

* School Attending Fall 2019:

* Current Youth Hockey Program/Team:

* Prior Skating/Hockey Experience (Select One):

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Work Phone or Cell Phone:

PARENT/GUARDIAN #2 (Required if player also resides with another parent)

Firstname:

Lastname:

Email:

Home Phone:

Work Phone or Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Cell Phone:

* Relationship to Player:

* PLAYER 2018-19 Season USA HOCKEY REGISTRATION NUMBER:

NOTE: Due to insurance requirements, ALL players for the "Skate with The Capitals" must be registered with USA Hockey for the current season (2018-19). Players not registered will not be allowed to participate.

Email Contact:
Program Director - Wes Riley - URAA@aol.com - 603-496-0146

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