Fall Ball Registration - Langley Blaze

Langley Blaze Registration Form

Blaze Registration

Fields marked with an * are required.

Player's First Name

Player's Last Name

Parents Name

Both Parent's First Name

Player's Email Address

Parent's Email Address

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)

Player's Cell Phone #

Format Example: 123-456-7890
(Use a hyphen between the numbers)

Address

Street Address

City

Country

Fill out all fields and capitalize the the Street Name, etc above

Current School

Graduation Year

Weight

Format Example: 185
(Only put the number)

Discount

Subtotal

Tax

Total USD