STAHA

                                              REGISTRATION FORM (PRINT THIS PAGE!!!!)                                     

PLEASE PRINT CLEARLY AND LEGIBLY

SELECT ONE: _____Mite ______Squirt _____Peewee _____Bantam_______Midget 18

·         Players Name__________________________________________________________________

Date of birth______________________________________             ____Male ___Female

USA citizen: _______Yes ________No

Home address ________________________________________________________

City_____________________________ State______________ Zip_______________

Home phone (______ ) ____________________________________________

• Player’s father ___________________________________________________________

Home address _____________________________________________________________

City_____________________________ State______________ Zip_________________

Home phone (______ )________________________ Work phone (____ ) ________________

Cell phone (____ )____________________Emergency phone (______ ) _________________

Email address ________________________________________________________________

• Player’s mother ______________________________________________________________

Home address _____________________________________________________________

City_____________________________ State______________ Zip_________________

Home phone (_____ )________________________ Work phone (_____ ) ________________

Cell phone (____ )____________________Emergency phone (______ ) _________________

Email address ________________________________________________________________

Position: ___Goalie _____Defense _____Forward:                   Shoots: _____ Left  ____Right

2007-2008 Team: __________________________________________Jersey #___________