Chinook Youth League Registration Form

Name: _________________________________ Gender: _____________

Address: _______________________________ Phone #: __________________

Postal Code: _______________________

E-mail Address (optional): ______________________________________________________

Birth Date: ___________________ (MONTH / DAY / YEAR)

Emergency contact name: ______________________Ph#___________________________

Division (circle one): Tiny Tot (suggested 3 – 5 year olds; 1 game/session)

Pee Wee (suggested 6 – 8 year olds; 2 games/session)

Bantam (8-10 years old as of Dec. 31st;

3 games/session)

Junior (11-14 years old as of Dec. 31st)

Senior (15-19 years old as of Dec. 31st)

Registration Fee: $75 + $125 Pre-payment of 1 case of chocolates

Total = $200 (1 case/family must be pre-paid with registration)

Total Fees paid with this registration = $_______________ (ca/ch/cr/db)

(please make cheques payable to Chinook Bowladrome)

Photo/Media Release – yes or no / Permission to contact via email – yes or no

(please circle one for each above)

Athlete/Legal Guardian signature__________________________________________

Chinook Youth League Registration Form

Name: _________________________________ Gender: ____________________

Address: _______________________________ Phone #: _________________________

_______________________________ Postal Code: _______________________

E-mail Address (optional): _____________________________________________