Roller Club Registration

Name*
First Last
Birth Date*
Month
Day
Year
Parent Name*
First Last
Parent 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.
2022 Calendar of Events*
Marsblade Development Dates (Milwaukee or Chicago)
April 1: MDP Kick Off: Chicago
April 9-10: MDP: Milwaukee
May 7-8: MDP: Location TBD
May 14-15: MDP: Location TBD
June 4-5: MDP: Location TBD
June 18-19: MDP: Location TBD
CLUB Tournaments
April 29-May 1: MidWest Wars: St. Louis (AA/AAA teams)
May 20-22: ECHO Tournament: Milwaukee (A teams)
Nationals
June 24-July 1: TORHS Nationals: Florida (ALL Teams)
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*