Kiski Area Hockey Association

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Kiski Area Hockey Association

PLAYER INFORMATION

You MUST register on-line with USA Hockey(IMR#) www.usahockey.com

* 2018 - 2019 USA Hockey #:

First Name:

Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

KISKI AREA SCHOOL ATTENDING:

Grade: 2018 - 2019 School Year:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Cell Phone:

Home Phone:

Work Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Cell Phone:

Home Phone:

Work Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Levels of Player Eligibility: (Coaches have final say in placement).

Developmental 3rd thru 6th grades

Middle School 7th & 8th grades

Jr. Varsity 9th thru 12th grades

Varsity 9th thru 12th grades

If paying by check still select the submit form tab at bottom of page.

Make check out to KAHA
give to KAHA the day of tryouts.

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IMPORTANT: Online Payment with credit cards is not active for this form

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