Howick Pakuranga Hockey Club Junior Registration Form

Player Details
First Name:
Surname:
Gender:	Male \| Female
Date of Birth: (DD/MM/YYYY)
Email Address: Please enter only one email address.
Confirm Email Address:
Street Address:
Suburb:
City:
Postcode:
Daytime Phone: Please enter only one phone number.
Evening Phone: Please enter only one phone number.
Mobile phone: Please enter only one Mobile number.
Did you play summer hockey?	Yes No
No. of seasons playing Club hockey
Rep Player? Please state Team / Year
School Information
School Name
School Year
Parent Information
Father's Name
Father's Email
Father's Mobile
Father's Occupation (optional)
Mother's Name
Mother's Email:
Mother's Mobile:
Mother's Occupation (optional)
Final Helpful Information
Shirt Size
Emergency Contact
Contact Person
Relationship to you:
Contact Phone number:
Club Help
Please tick beside where you can help the club:
Coach \| Manager \| Umpire \| Fundraising \| Sponsorship \| Gear \| Administration
Terms and Conditions
	I have read our terms and conditions