Registration and Waiver Forms Goalie First Name Goalie Last Name Address Address Line 2 City State / Province ZIP / Postal CodeZIP / Postal Code CountryCountryUnited StatesCanadaDate of Birth MM slash DD slash YYYY Winter Hockey Association Jersey SizeYXLASAMALAXL2XL3XLParent/Guardian info Parent First Name Parent Last Name Address Address Line 2 City State / Province ZIP / Postal CodeZIP / Postal Code CountryCountryUnited StatesCanadaMobile NumberHome Number Email Insurance InfoName of Insurance Company* Policy Number Consent to the waiver. By checking this box, you agree to read and understand the waiver. CommentsThis field is for validation purposes and should be left unchanged.