File - London Minor Ball Hockey Association

Dick Price 519 777 4519
Jason Power 519 636 4743
General Inquires: info@LMBHA.com
$110.00 – Squirt 10 games
$140.00 – Tyke & Novice divisions 12 games
$155.00 – all other divisions 14 games
All Participants receive personalized Jersey/Shirt, Shorts, Socks & Water Bottle
Divisions Offered
Squirt
2009-10
Tyke
2007-08
Novice
2005-06
Atom
2003-04
Peewee
2001-02
Bantam
1999-00
Junior
1997-98
Girls U14
2001-02
Girls U16
1999-00
Girls U18
1997-98
● All programs are offered mainly on Saturday’s and/or Sunday’s beginning in May and ending in late July ●
● Up to a 14 regular season and playoff games ● Full Player and Team Statistics available on the Internet ●
● All games played at Farquharson Arena ●
● Hone your ice hockey skills and build on your endurance during the off season ●
● One game a week on average with no practices ● Provincial Team Opportunities ●
● Awards, Pizza, Adventures On Wonderland, Swimming, Bowling and Paintball offered during our
Year End Celebration of Excellence ●
● Limited dental & medical insurance ● OBHA Certified Referees ● Fun, safe and make new friends ●
Mandatory equipment required includes
CSA Approved Hockey helmet with full facial protection, hockey gloves, soccer style shin pads and athletic cup
Proud members of the
Registration Dates & Locations
We offer two easy ways to register:
1) Register in person at one of the registrations dates and locations below (Cash or Cheque only)
2) Register Online Anytime (convenience fees do apply) at www.lmbha.com
Nichols Rec Centre & Arygle Arena
1:00 pm – 3:00 pm
Sunday, January 25
Sunday, February 8
Sunday, February 22
Deadline to register March 31.
Registration after March 31 will be
accepted only if space is available
and are subject to a $20.00 late fee
Team Building sessions start
in Mid April
Nichols Rec Centre & Arygle Arena
1:00 pm – 3:00 pm
Sunday, March 8
Sunday, March 22
Ball Hockey.... As Canadian As It Gets!
48 Langarth Street E., London, Ontario, N6C 1Z1
Tel: 519 777 4519 or 519 636 4743, E-mail: info@LMBHA.com
Player Information:
□ Squirt
□ Tyke
□ Novice
□ Atom
□ Peewee
2009-2010
2007-2008
2005-2006
2003-2004
2001-2002
□ Bantam
□ Junior
□ Girls U14
□ Girls U16
□ Girls U18
1999-2000
1997-1998
2001 or before
1999 or before
1997 or before
Name: ____________________________________ Birth Date: (D)_____ /(M)_____ / (Yr)_____ Male ____ Female ____
Address: __________________________________________ City: _________________ Postal Code: ______________
Parent Information:
Parent’s Name:____________________________________
Parent’s Name:____________________________________
Home #: ________________________________________
Home #: ________________________________________
Cellular #: _______________________________________
Cellular #: _______________________________________
Email: __________________________________________
Email: __________________________________________
Questions & Volunteers
□
AAA
□
AA
□
□
No
□, if yes , how many years __________
2.
For Ball Hockey, my child is a: Player
3.
Did your child play ball hockey last year?______ if yes, which coach/team? ___________________________________
4.
Are you willing to help with Coaching or being an Assistant? Coach:_______ Assistant:_______
Goalie
□
Experience:
Yes
Select
□
Has your child ever played ice hockey?______ if yes, which level
□
A
□
1.
Houseleague
5. Are you ok with the LMBHA posting a picture of your child for his personal profile page on the league website? *No
personal information other than your childs name and his LMBHA statistics will be displayed on this page. YES or NO
6.
Please write your childs top 3 choices for their jersey number 1st _____ 2nd _____ 3rd _____
7. Is your child interested in trying out for the leagues provincial team? _____ *If selected to the team, an additional $30
will be due for extra floor time.
8. Does your child have a friend/relative they wish to play with? NOTE: This request MUST be a single request & mirrored
on the other participants form *please contact office for further clarification*
_____________________________________
9)
Does your child require a shirt/jersey larger or smaller than the divisional standard? ______
If Yes, please state the desired size _______. A sizing chart is available on our website.
Registration Fee:
□ $110.00
□ $140.00
□ $155.00
□ $30.00
Squirt
Tyke & Novice
All Other Divisions
Provincial Rep Squad
□ Early Bird Plan - Save $20 when registering before February 15, 2015
Received by: ____________
□ Cash □ Cheque #_______________ Payable to: London Minor Ball Hockey Association
How did you hear about us?
_________________________________________________________
Waiver:
In consideration of the London Ball Hockey Association (LBHA) permitting the player
to participate in any of the activities of the LBHA, I, for myself, my family, heirs,
successors, and executors hereby indemnify and hold harmless the LBHA, it’s
directors, officers, successors, and assigns, from all costs, claims, actions, damages,
or liabilities, whatever their nature or however caused, resulting from the
participation of the player in any activities of the LBHA.
Parent/Guardian Signature: ______________________________________
Medical Issues:
__________________________
__________________________
__________________________
__________________________