Registration Form

* = required


* First Name:
* Last Name:
* Gender:
* Date of birth:

* Address:
* City:
* Postal Code:	(ex: A1B2C3)

* E-Mail Address:
Alternate E-Mail Address:
* Phone:
Cell:

* Position:
* Last team played for:

Mother:
Father:

Programs:	Upon selection of your date of birth, appropriate programs will be made available.

Registration and Payment Requirements * Please note that registration alone does not secure your spot. It must be accompanied with your payment for the desired programming sessions.

Send cash or cheque payable to: Laker Hockey Academy 52 Bridgetown Dr, Winnipeg, MB, R3X 2J8 -OR- Send e-Tranfer to lakerhockeyacademy@hotmail.com

* Successful registration should be accompanied by auto-generated e-mail immediately following online registration. If you do not receive this e-mail within 5-10 minutes of online registration, please e-mail info@lakerhockeyacademy.ca. This is in regards to e-mail possibly being blocked by spam filters, or directed to your junk/spam folder.