The GEM Benefits Inc U17 Ontario Hockey Prospects Cup Player Name: ____________________________________________________________ First Address: Middle Last ____________________________________________________________ ____________________________________________________________ Birth Date: __________Height: _________ Weight: __________Shoots: ________ Position: __________ dd/mmm/yyyy 2017/2018 Team: ____________________________________________________________ 2016-2017 Stats: Player ________________________________________________ Goals Goalie Assists PIM ________________________________________________ GM/mins played Wins Losses Shutouts PIM Parent/Guardian: ____________________________________________________________ Parents/Guardian MUST Name Attend event with player. NO PLAYER will be allowed ____________________________________________________________ on the ice without their Parents/Guardian ____________________________________________________________ Name Address Address Address Address ____________________________________________________________ Phone Phone ____________________________________________________________ Email Single $125.00 Regular Email Early Bird $100.00 Before Sept 1, 2018 Group $90.00/each 3 or more players apply together before Sept. 1, 2018 Signatures: Player __________________________ Parents/Guardian:__________________________ Payments made through E Transfer only Mail or Email registration form 406 Simcoe Street, Woodstock, ON N4S 1J7 contact: ezprint1@outlook.com www.facebook.com/hockeyprospectsu17/ www.u17ontariohockeyprospects.com Cheque # Amt $ Office Use Only Date received Verified by U17 Ontario Hockey Prospects Cup reserves the right to cancel event and provide a full refund with notice. Hockey is dangerous, your participation in the U17 Ontario Hockey Prospects Cup and combine is done so at your own risk. CSA approved hockey equipment is required for all games including a full face mask. U17 Ontario Hockey Prospects Cup offers no guarantee written, implied or otherwise of being invited or making any Jr hockey teams.
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