HOUSE PROGRAM and GIRLS
Office Use Only: Birth Certificate Attached: Release Rec'd: Monroe County Youth Hockey 9227 SE 179th Wesley St The Villages FL 32162 585-663-5580 x4 www.MCYH.org
REGISTRATION FORM
HOUSE PROGRAM and GIRLS 2018-2019 Season PLEASE PRINT ALL INFORMATION CLEARLY _______________________________________________________ Player’s Name Last, First
____/____/____ Birthdate
Male _____ Female _____
Citizenship _________
________________________________________________________________________________________________________________________ Address City State Zip Code _______________________________________________________ Parent/Guardian Last Name First Name
I.
(_____) ___________________ Primary Phone
RINK PREFERENCE (CIRCLE ONE):
_________________________________ Email Address
Lakeshore
SIA
(Initiation at SIA only)
II. LAST ORGANIZATION: ________________________________________________ (ORIGINAL PLAYER RELEASE FORM REQUIRED IF NOT MCYH)
III. PROGRAM CHOICE (please indicate program and age classification, where applicable): INITIATION
League Fees
AGE Entry Initiation (Beginner) 1x/week 20 wks
4-8 yrs
$200
Entry Initiation ( Beginner) 2x/week 20 wks
4-8 yrs
$400
INITIATION FEES DUE 10/1/2018
HOUSE and GIRLS
DIVISION
AGE
DATE OF BIRTH
7-8 yrs
1/1/2010 – 12/31/2011
$645
Enhanced
9-10 yrs
1/1/2008 - 12/31/2009
$960
PeeWee
Enhanced
11-12 yrs
1/1/2006 - 12/31/2007
$995
Bantam
Enhanced
13-14 yrs
1/1/2004 - 12/31/2005
$1110
Midget
Enhanced
15-19 yrs
1/1/2000 - 12/31/2003
$1125
Girls 16U Non-Tournament
16 & under
2002 and younger
$945
Girls Tier II 14U Travel
14 & under
2004 and younger
$945
Girls Tier II 16U Travel
16 & under
2002 and younger
$945
Girls Tier II 19U Travel
19 & under
1999 and younger
$945
Include non-refundable $150 deposit towards League Fees with registration.
8U (Red White & Blue ) Squirt
All players NEW to MCYH must also submit a copy of player’s passport or birth certificate. League Fees due in-full 7/31/2018 Register online at www.mcyh.org after July 31. ALL NEW REGISTRATIONS RECEIVED AFTER THE PROGRAM DUE DATE WILL BE SUBJECT TO A $50 LATE FEE.
For additional information regarding any of the above listed programs, please refer to the MCYH Registration and Guidebook found at the MCYH website (www.MCYH.org) or by contacting the program directors listed in the MCYH Registration and Guidebook.
IV. PAYMENT OF DEPOSIT (Final payments to be made on-line at www.mcyh.org; see website for further information) DEPOSIT: I am enclosing cash or check #
___________ in the amount of ___________________
I am paying by credit card at rink. Office use only CC Authorization code: ________________ I authorize you to charge my credit card as follows: MC
VISA DISCOVER _______________________________________ ______________ ____________ __________ Card #
3 digit Security #
Expiration date
Amount
I understand that all league fees are due and to be paid in full by July 20, 2018 (Travel) or July 31, 2018 (House and Girls). New Registrations and/or payments received after these dates will automatically incur a $50 late fee in addition to the stated League Fees, payable-in-full before participation in any Monroe County Youth Hockey events.
____________________________________________________________ Parent or Guardian Signature
REGISTRATION FORM
HOUSE PROGRAM and GIRLS 2018-2019 Season PLEASE PRINT ALL INFORMATION CLEARLY _______________________________________________________ Player’s Name Last, First
____/____/____ Birthdate
Male _____ Female _____
Citizenship _________
________________________________________________________________________________________________________________________ Address City State Zip Code _______________________________________________________ Parent/Guardian Last Name First Name
I.
(_____) ___________________ Primary Phone
RINK PREFERENCE (CIRCLE ONE):
_________________________________ Email Address
Lakeshore
SIA
(Initiation at SIA only)
II. LAST ORGANIZATION: ________________________________________________ (ORIGINAL PLAYER RELEASE FORM REQUIRED IF NOT MCYH)
III. PROGRAM CHOICE (please indicate program and age classification, where applicable): INITIATION
League Fees
AGE Entry Initiation (Beginner) 1x/week 20 wks
4-8 yrs
$200
Entry Initiation ( Beginner) 2x/week 20 wks
4-8 yrs
$400
INITIATION FEES DUE 10/1/2018
HOUSE and GIRLS
DIVISION
AGE
DATE OF BIRTH
7-8 yrs
1/1/2010 – 12/31/2011
$645
Enhanced
9-10 yrs
1/1/2008 - 12/31/2009
$960
PeeWee
Enhanced
11-12 yrs
1/1/2006 - 12/31/2007
$995
Bantam
Enhanced
13-14 yrs
1/1/2004 - 12/31/2005
$1110
Midget
Enhanced
15-19 yrs
1/1/2000 - 12/31/2003
$1125
Girls 16U Non-Tournament
16 & under
2002 and younger
$945
Girls Tier II 14U Travel
14 & under
2004 and younger
$945
Girls Tier II 16U Travel
16 & under
2002 and younger
$945
Girls Tier II 19U Travel
19 & under
1999 and younger
$945
Include non-refundable $150 deposit towards League Fees with registration.
8U (Red White & Blue ) Squirt
All players NEW to MCYH must also submit a copy of player’s passport or birth certificate. League Fees due in-full 7/31/2018 Register online at www.mcyh.org after July 31. ALL NEW REGISTRATIONS RECEIVED AFTER THE PROGRAM DUE DATE WILL BE SUBJECT TO A $50 LATE FEE.
For additional information regarding any of the above listed programs, please refer to the MCYH Registration and Guidebook found at the MCYH website (www.MCYH.org) or by contacting the program directors listed in the MCYH Registration and Guidebook.
IV. PAYMENT OF DEPOSIT (Final payments to be made on-line at www.mcyh.org; see website for further information) DEPOSIT: I am enclosing cash or check #
___________ in the amount of ___________________
I am paying by credit card at rink. Office use only CC Authorization code: ________________ I authorize you to charge my credit card as follows: MC
VISA DISCOVER _______________________________________ ______________ ____________ __________ Card #
3 digit Security #
Expiration date
Amount
I understand that all league fees are due and to be paid in full by July 20, 2018 (Travel) or July 31, 2018 (House and Girls). New Registrations and/or payments received after these dates will automatically incur a $50 late fee in addition to the stated League Fees, payable-in-full before participation in any Monroe County Youth Hockey events.
____________________________________________________________ Parent or Guardian Signature
