Youth Street Hockey Registration

*Please choose a site

Parent/Guardian Information

*Contact First Name

*Contact Last Name

*Email

*Confirm Email

*Phone

*Address

Address 2

*City

*State

*Zip

Youth Participant Information

*First Name

*Last Name

*Birth Date

Recreation Center Membership Number

(Though not required for registration, your child will have to become a Recreation Center member to participate in Street Hockey.)

*If your child has a medical problem that the instructor should be aware of, please describe it briefly. Please note last occurrence. If none, please indicate so.

Emergency Contact Information

*Emergency Contact First Name

*Emergency Contact Last Name

*Emergency Contact Relationship to Child

*Emergency Contact Phone

*I affirm that my child is 5-17 years old and all the information entered is correct. *I also authorize the City of New York Department of Parks & Recreation and the New York Rangers to photograph or film me and to use such photographs or film for printed materials, broadcasts, displays or newspaper publications. *I understand that my child's participation is contingent upon the completed waiver form [PDF] being signed and returned to Parks prior to the start of the League.