17U 2026-2027 - Registration

First Name *

Last Name *

Birthday *

Players Preferred Position *

Email *

Parent #1 First Name *

Parent #1 Last Name *

Parent #1 Phone Number *

Add Parent

Parent #2 First Name *

Parent #2 Last Name *

Parent #2 Phone Number *

Address *

City *

Postal Code *

Province *

Comment

Consent for Photo/Video Use

By checking this box, I give permission to Dauphin Junior Rec Hockey League to use my image, likeness, and/or voice as captured in photographs or videos for promotional, marketing, or educational purposes. I understand that these materials may be used in print, online, and other media without further notice or compensation to me. I waive any right to inspect or approve the finished product or materials.

Acknowledgement *

I acknowledge that Dauphin Junior Rec Hockey League is not responsible for lost or stolen items.

Amount

$

Payment Method *

Credit Card $100x4 CC Installment Plan (Instructions will be emailed to you) Etransfer to payment@drhljr.ca (please send immediately or within 24 hours) Cheque payable to "DRHL Jr Division"

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Credit or debit card*

REGISTRATION

Registration

Player Information

Parents Information

Payment Information