Parkland Hockey Academy

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Online Registration

Please complete the following form to submit your application for the Parkland Hockey Academy's upcoming school year. All information will be used for registration processes, and website profiles. If you are concerned with what information we are providing to the general public, please visit our profiles page and see for yourself.

Parent #1 Email Requires A Valid Email Address.
All registration information will automatically be emailed to the address within this field.

All Fields Are Required.

Student Information

First Name:
Last Name:
Parent #1 Email:
Parent #2 Email:
Student Email:
Gender:
Birthdate:
Health Care Number:
Address:
City:
Postal Code:
Upcoming School / Grade:
Last Team Played:
Upcoming Level:
Position:
Clothing Size:
Jersey Size:
Player Bio Information

Shoots / Catches:
Hockey Number:
Height:	' "
Weight:	lbs (Optional)
Hockey Aspirations: (how you see your future in hockey)
Favorite Food:
Favorite Movie:
Favorite NHL Player:
Greatest Influence On Your Hockey Career & Why: (Optional)
Emergency Information

Parent #1:
Parent #1 Home Phone:
Parent #1 Cell Phone:
Parent #1 Work Phone:
Parent #2:
Parent #2 Home Phone:
Parent #2 Cell Phone:
Parent #2 Work Phone:
Emergency Contact:
Emergency Contact Phone:
Medical Concerns:

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June 16th & 18th groups

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June Schedule/Middle School

Wed June16 * Testing Group on ice ...

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