Nazareth Ice Oasis In-House Youth Hockey League

Player Information

First Name *

Last Name *

Date of Birth *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

League *

D1 (16U) Bantam - High School (TBD) & Sunday 8:00 AM

D2 (13U) Squirts and Peewee Thursdays @4:40 PM & Sundays @ 8:00 AM

D3 (9U)) Mites -Squirts (Tuesdays @4:40 PM & Sundays @10:15 AM)

Jersey Size *

Gender *

Male

Female

Playing age as at start of season *

School Name Required Only for D1 (16U)

Grade In School

Played in league last year? *

Yes

No

Family Information

Home Phone *

Primary Email Address *

Alternate Email Address

Father's Name

Mother's Name

Father's Phone

Mother's Phone *

Father Can Help As *

Mother Can Help As