Howick Pakuranga Hockey Club Senior Registration Form

Player Details:
First Name:
Surname:
Gender:	Male \| Female
Date of Birth: (DD/MM/YYYY)
Email Address:
Confirm Email Address:
Street Address:
Suburb:
City:
Postcode:
Daytime Phone:
Evening Phone:
Mobile phone:
Did you play summer hockey?	Yes No
Team played in last winter?
Position/s you wish to play?
Rep Player? Please state Team / Year
Club Help
Please tick beside where you can help the club:
Coach \| Manager \| Umpire \| Fundraising \| Sponsorship \| Gear \| Administration
Teams you wish to trial for
Select the team/s you wish to trial for
Premier 1 & Premier Reserve Divisions 1 & 2 Divisions 3 to 5	Youth A Youth B
Parent/Guardian Information (if under 18)
1st Parent/Guardian's name
Email
Mobile
Occupation (optional)
2nd Parent/Guardian's name
Email:
Mobile:
Occupation (optional)
Uniforms
Shirt Sizes
Shorts / Skirts
Final Helpful Information
Occupation or School / Uni name:
If a goalie, do you own your own gear?:
Emergency Contact
Contact Person
Relationship to you:
Contact Phone number:
Last minute comments
Comment:
Terms and Conditions
	I have read our terms and conditions