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SCSHA NEW PLAYER REGISTRATION

FALL SEASON

 

 

PLAYERíS NAME:______________________________________________††††† SEX:†† M†††† F

††††††††††††††††††††††††††††††††††††††††††††††† (LAST NAME)††††††† †††††††† (FIRST NAME)††††††††††† (MIDDLE IINITIAL) ††††††††††† (CIRCLE ONE)

 

DATE OF BIRTH__________††† ___

†††††††††††††††††††††††††††††††††††††††††††† (MONTH/DAY/YEAR)

 

ADDRESS ____________________________________________________________________

 

CITY ________________________________STATE __________ZIP CODE _____________

 

HOME PHONE (_____)_________________ALT. PHONE†† (______)_________________

 

FATHERíS NAME††††† __________________________________________________________

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† (LAST NAME)††††††††††††††††††††††††††††††††††††††††††††† (FIRST NAME)

MOTHERíS NAME††† __________________________________________________________

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† (LAST NAME)††††††††††††††††††††††††††††††††††††††† (FIRST NAME)

PLAYERíS POSITION__________________††††††††††††† SHOOTS :†† RIGHT††††† LEFT

 

DOES PLAYER WISH TO BE A GOALIE? †††††††††††YESorNO

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††† CIRCLE ONE)

 

TEAM OR ASSOCIATION PLAYED FOR LAST SEASON_______________________________

 

 

*** Mite through Midget Players ***

 

All players from Mite through Midget.Non-refundable regular registration fee of $125.00 per player/$250.00 per family must accompany this form.

 

MAIL THE COMPLETED APPLICATIONAND

A COPY OF THEPLAYERíSBIRTH CERTIFICATE TO:

S.C.S.H.A. REGISTRAR

P.O. BOX653

ST. CLAIR SHORES,MI48080-0653

 

 

THIS AREA FOR SCSHA LEAGUE USE ONLY

 

POSTMARK DATE________________________†† DIVISION/AGE CLASSIFICATION__________________________

 

 

 

ALL PLAYER REGISTRATIONS WILL ONLY BE

ACCEPTED FROM THE S.C.S.H.A.P.O.BOX

 

 

 

 

PLAYER REGISTRATION MUST INCLUDE THE FOLLOWING OR WILL BE RETURNED:

 

1.)     COMPLETED REGISTRATION FORM

2.)     CORRECT REGISTRATION FEE CHECK OR MONEY ORDER MADE PAYABLE TO S.C.S.H.A.

 

MAIL COMPLETED REGISTRATION FORM AND PAYMENT TO:

S.C.S.H.A.

P.O. BOX653

ST. CLAIR SHORES,MI48080-0653

 

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