The Youth Pickup Hockey Program is designed to provide an atmosphere where boys and girls can work on their skills and conditioning in a supervised no-pressure atmosphere.  Pickup Hockey is for all hockey players age 5-18.  There are two sessions, one for Mite, Squirt and Bantam age players; and one for Midget/High School players.  All sessions will be supervised and lines and teams will be determined based on skill level, to ensure fair play and maximize skill development.

 

 

Student Name: _______________________________________                               

Parent/Guardian Name: ________________________________              

Address: ____________________________________________              

City: _______________________________________________              

State: ___________________            Zip: ___________________                              

Phone: _____________________________________________                                

Email: _____________________________________________

Date of Birth: _____/_____/_____    Age: ______  Gender: M or F

2007-2008 Team and Level Played:_______________________

 Individual Session - Member        $15.00                       $_______

 Individual Session - Non-Member $20.00                     $_______

 10 Session Punch Card - Member $125.00                   $_______

 10 Session Punch Card - Non-Member $150.00          $_______

 20 Sessions Prepaid - Member $235.00                         $_______

 20 Sessions Prepaid - Non-Member $275.00               $_______

*Member discount applies to those registered for the 2007-2008 season of Moon Hockey, WA Hockey, QV Hockey and the Pittsburgh Aviators.

Office Use Only:        Payment Type

Date Received:___________________________________

Cash: __________________________________________

Check #: _______________________________________

Credit Card #:___________________________________

Expiration date: _________________________________