Roller Club Registration

Name*
First Last
Birth Date*
Month
Day
Year
Parent Name*
First Last
Parent Email*
Secondary Email
Parent Phone*
Parent/Guardian Name
First Last
Parent/Guardian Email
Parent/Guardian Phone
Address
Street Address Address Line 2 City State ZIP Code
Do you play ice hockey?*
- Yes
- No
If yes, what organization and what team did you play on this year? (Example: Waukesha Pee Wee C)
If no, would you rate yourself as a beginner or intermediate player?
Did you play club last season?*
- Yes
- No
If yes, what was your number?
Jersey Number Preference; Please choose 3 numbers*
List three numbers separated by commas.
2023 Calendar of Events*
Regional Tournaments
April 28-30: MidWest Wars, St Louis, MO
May 19-21: TORHS Regional, St Louis, MO

MARSBLADE DEVELOPMENT PROGRAM (MDP)
Inter-CLUB Training & Games with the IRHL
April 15-16: MKE
May 13-14: CHI
June 2-4: MKE

National Tournaments
June 22-29: TORHS, Tampa, FL (ALL Teams)
July 6-16: NARCh, Irvine, CA (optional event TBD)
By checking the box I confirm that I am able to commit to the National Tournament.
- Yes
Farm Practice Day Requests
List preferred practice days for training at the farm. We will try to accommodate requests, but cannot guarantee they will be fulfilled.
Comment
Include any comments or questions regarding the clinic, camp, or program.
Liability Waiver*
- Yes
I have read and agree to the liability waiver and terms and conditions.
Parent or Legal Guardian*