Register Here for the 2023 Roller Hockey Club 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 PhoneAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 RequestsList preferred practice days for training at the farm. We will try to accommodate requests, but cannot guarantee they will be fulfilled. CommentInclude 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*