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London Blizzard Sledge Hockey Club

2025-2026 Hockey Season Registration Form

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Birthday

Year

Month

Day

Diagnosis/Disability

Spinal Cord

Spina Bifida

Other

Allergies/Special Needs

Emergency Contact phone number

Parent/Guardian

Relationship to player

Parent/Guardian phone number

I give permission for my child and/or myself to be photographed/videotaped and use in Blizzard promotions.

I give permission for my telephone number and email address to be given to other team players.

I am aware that I am responsible for arranging my own transportation to and from all practices, games and tournaments.

Signature

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Date

Year

Month

Day

Annual Season Fee: $400

($90 insurance - OSHA, $310.00 London Blizzard Registration Fee)

Cheques payable to “London Blizzard Sledge Hockey Club”

NOTE: Registration is not complete until payment has been received.