PERMISSION TO SKATE Request Form (Dorchester Minor Hockey Association)

PERMISSION TO SKATE Request Form

Please complete the following to request a Permission to Skate form.

Players First Name^*

Required

Players Last Name^*

Required

Date of Birth^*

Required

Parent/Guardian(s) First Name^*

Required

Parent/Guardian(s) Last Name^*

Required

Home Address (Street)^*

Required

Home Address (Town)^*

Required

Home Address (Postal Code)^*

Required

Email Address^*

Required

Phone Number^*

Required

Example: ###-###-####

Home Centre^*

Required

AAA Zone^*

Required

If Dorchester is Home Centre, Elgin-Middlesex Is AAA Zone

Previous Season Team^*

Required

Team Trying Out For^*

Required

Please include division and level.