Jr. Eagles Registration Form

Primary contact for this application (please write Full Name)

Phone number

Email address

Please indicate your relationship to the player in this application:
—Please choose an option—PlayerParent/GuardianOther

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Player's first name

Player's middle name

Player's last name

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Please select which division you are applying for:
—Please choose an option—U18U16

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Address (Line 1)

Address (Line 2)

City

Province/State

Postal Code

Citizenship
—Please choose an option—CanadaUnited StatesDual Citizen

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Player's height (feet/inches)

Player's weight (pounds)

Player's position (primary)
—Please choose an option—CenterLeft WingRight WingDefenseGoaltender

Player's handedness
—Please choose an option—LeftRight

Player's birth year
—Please choose an option—2004200520062007

Player's birth month
—Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Player's birth day
—Please choose an option—12345678910111213141516171819202122232425262728293031

Previous/current team or organization

Current level
—Please choose an option—Junior AJunior BU18/Major MidgetU16/Minor MidgetU15/Major BantamCSSHLMidget A1Midget A2Bantam PrepUSA Prep

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Parent/Guardian's name

Parent/Guardian's phone number

Parent/Guardian's email address

Parent/Guardian 2's name

Parent/Guardian 2's phone number

Parent/Guardian 2's email address

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Notes/Comments (optional)

MEDICAL INFORMATION: Please complete the Medical Information Form available on our Jr. Eagles page, and submit to damon@surreyeagles.ca

I accept the terms and conditions as listed above for this application.
I Accept