Fall Ball Registration - Langley Blaze

Langley Blaze FALL BALL Registration Form

Please make sure you follow the format requested.

Fields marked with an * are required.

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Player's First Name

Player's Last Name

Parents Name

Both Parent's First Name

Parent's Email Address

Player's Email Address

If the player does not have an email address, put NA.

Do not put the parents email address.

Please note, a player email address is needed for the Premier and Junior teams.

Player's Birthdate

Format Example: YYYY-MM-DD or 2000-06-25
(Must use a hyphen between year, month, day)

Parent's Cell Phone #

Format Example: 123-456-7890
(Use a hyphen between the numbers, PLEASE use this format)

Player's Cell Phone #

Format Example: 123-456-7890

(Use a hyphen between the numbers, PLEASE use this format)

If the player does not have a cell number, put NA.

Do not put the parents cell phone number.

Please note, a player cell number is needed for the Premier and Junior teams.

Address

Street Address

City

Country

Use Proper punctuation please. Fill out all fields and capitalize the the Street Name, etc above. (Example: 1234 Street Name)

Weight

Format Example: 185
(Only put the number)

Graduation Year

Current School

What team did you play for previously?

Payment

Discount

Subtotal

Tax

Total USD