U11,U13,U15,U21 DIVISION REGISTRATION | Breakaway Performance Hockey

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REC
(U11, U13,U15,U18)

DIVISION
REGISTRATION

PLAYER / PARENTS
INFORMATION

Players Full Name

Female / Male

AGE

Association Played for in 2025-26 season

Date of Birth

SINGLE PLAYER REGISTRATION *

Yes

No

PLAYER REGISTERING AS *

PLAYER

GOALIE

DIVISION (2025/26 Season) * Required

U9

U11

U13

U15

U18/21

TEAM REGISTRATION *

Yes

No

TEAM NAME

Have You Played In Our Summer 3on3 Program Before? *

Yes

No

What Level Do You Play Currently * Required

LL

REP

A

AA

AAA

Jersey Size (Youth)

XL (42"-44")

Large (40"-42")

Medium (38-40")

Small (36"-38")

GOALIE CUT

GOALIE CURRENT SIZE

Jersy Size (Adult)

XXXL (57"- 59")

XXL (55"- 57")

XL (53"- 55")

Large (49"- 51")

Medium (45"- 47")

Small (41"- 43")

GOALIE CUT

Parents Full Name

Street Address

Parents Full Name (OTHER)

City

Postal Code

Email

Contact Number

Do you have any questions or comments?

* Players will be playing in the same division that they played in during the 2025-26 winter season

* Spots will ONLY be confirmed once payment has been completed

$380
PER PLAYER

* Payment can be made via EMAIL To:
tonyturner77@hotmail.com

© Breakaway Performance Hockey Skills & Development •

breakawayperformancehockey@gmail.com • Wasaga Beach, ON

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