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* Indicates Required Field

Player Information

PLEASE READ BEFORE REGISTERING

If you are under 19 years of age this registration must be filled out by your parent or guardian with the parent data section completed.

If you are registering as a returning player and do not have your Access Code please click on the link What's My Access Code? and complete the steps and your access code will be emailed to you. If you have changed your email address from your last registration and need assistance retrieving your Access Code please contact Jeff Dyrblom at pgballhockey@gmail.com and provide your first and last name and date of birth.

Are you a returning Player?

Yes No

First Name *

Last Name *

Birthdate *

Access Code

(Only returning players need to enter the Access Code.)

What's my Access Code?

Email Address *

Verify Email Address *

Gender

Not Specified Male Female

Position *

Last Team *

Address *

City / Hometown *

Province *

Postal Code *

Phone Number *

League *

If you know what team you would like to be added to, please select the league (if applicable) and or team.

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Verify Parent/Guardian Email Address

Parent/Guardian Phone Number

Use Above Address

Parent/Guardian Address

Parent/Guardian City

Parent/Guardian Province / State

Parent/Guardian Postal / Zip Code