STETTLER MINOR HOCKEY ASSOCIATION

REGISTRATION FORM 2012 - 13

NAME: ______BIRTH DATE: ______
Month Day Year

AGE: ______LEVEL: ______

PHONE(HOME) ______(WORK) ______(CELL)______/______

MAILING ADDRESS: ______

Street or Box Town Postal Code

LEGAL LAND DESCRIPTION IF BOX NUMBER ______

PERSONAL HEALTH CARE NUMBER: ______BC#______

E-MAIL ______

______

MOTHER’S NAME FATHER’S NAME (if applicable)GUARDIAN’S NAME’S

PLEASE HAVE PROPER ID FOR PLAYER IN HAND AT TIME OF REGISTRATION

Alberta health Care and Birth Certificate. All necessary forms(if applicable)

The Stettler Minor Hockey Association is offering four equal payments of fees for participants. If you choose this option, the first payment will be due upon registration along with three post datedcheques for Oct. 15, Nov. 15 and Jan. 15/13. We will also require a postdated cheque for $200 to theSMHA , dated Feb 15/13. If your family (15 yrs and older) works the required 8 hours for volunteer hours, your cheque will be returned. If you do not work the required 8 hours, your cheque will be cashed on Feb 15, 2011. PLEASE NOTE: REGISTRATIONS WILL NOT BE ACCEPTED WITHOUT RECEIPT OF FULL PAYMENT AND/OR POSTDATED CHEQUES. IF YOU NEED TO MAKE ALTERNATE ARRANGEMENTS FOR PAYMENT, PLEASE SPEAK TO ANY SMHA BOARD MEMBER. NO CHILD WILL BE ALLOWED ON THE ICE WITHOUT FIRST BEING REGISTERED WITH THE SMHA. WHICH INLCUDES PAYMENT OF FEES.

There will be a $50 late payment charge for anyone not registered on Registration dates.

For all players that have not played with SMHA for the past 2 consecutive years must pay $200 nonrefundable fee. If the player continues with SMHA this fee will go towards registration fees.

CIRCLE AN AGE CATEGORY

MITE / NOVICE / ATOM / PEEWEE / BANTAM / MIDGET
BORN / 06/07 / 04/05 / 02/03 / 00/01 / 98/99 / 95/96/97
FEE / $180 / $318 / $510 / $570 / $630 / $690
Payment Plan / 4 x $45 / 4 x $79.50 / 4 x $127.50 / 4 x$142.50 / 4 x $157.50 / 4 x $172.50

Last team played for &(Association)______

Out of SMHAboundary Player YES ____ NO ____

Have player verification form completed YES ____ NO ____

Have Release form completed YES ___ NO _____

Have completed Permission to try out form from previous association YES ____ NO____

IS THE REGISTRANT A GOALTENDER? ______ARE YOU NEEDING EQUIPMENT? ____

REGISTRATION COST $______IMPORT PLAYER $200.00 + $60.00 TRY OUT FEE

AA Team Try Out Fee $60.00______Atom, Peewee, Bantam, Midget

TOTAL (SMHA)$______SMHA Volunteer TOTAL ______$200.00 (Cheque name & number)

For Office Use

Paid cash ______Paid by cheque(name-number) ______Paid by 4 post datedcheques ______Fundraising Cheque ______$200.00 dated March 30 of 2013

Included on this cheque is family members fees,______(players names)