Registration - Hockey Night in Boston

Player Information

Player's First Name*

Player's Last Name*

Player's Street Address*

Address Line 2

City*

State*

ZIP / Postal Code*

Player's Email

Enter Email Confirm Email

Player's Cell Phone

Parent / Guardian Contact Information

Parent/Guardian Name*

First Last

Parent/Guardian Email*

This email will be used for all correspondence, so please provide us with an email you check regularly.

Enter Email Confirm Email

Parent/Guardian Cell Phone*

Home Phone

Scholastic Information

Please provide us with the player's scholastic information. This information is for HNIB's internal use ONLY.

Current School*

Current School Year*

Next year's anticipated school*

School year in Fall of 2019*

ATTENTION:

Post-grads at a prep school or junior program are eligible. However, if you are expecting to go to, or take college courses in the Fall, then you are not eligible to play in this event. If you have any questions, please call the HNIB office at 978-682-2425.

Current GPA

Additional Sports

Hockey Information

Please be as accurate as possible when providing this information.

Coaches Code

**ONLY ENTER THIS IF YOU ARE INSTRUCTED TO DO SO BY A COACH, OTHERWISE, PLEASE LEAVE IT BLANK!!**

Date of Birth*

Position*

Forward
Defense
Goaltender

Are you the starting goalie on the varsity team?*

Yes
No
Split time ~50/50 with other goalie

Shooting Hand (catching hand if goalie)*

Left
Right

Height*

Weight*

Current Team*

Current Hockey Level/League*

(e.g. HS Varsity, USPHL Elite, u18AAA etc...)

Supplemental team(s)

(e.g. half-season team, tournament team, etc...)

Next season's anticipated team

Next season's anticipated hockey level/league

(e.g. HS Varsity, USPHL Elite, u18AAA etc...)

Current Season's Goals (Games played if goalie)

**Leave blank if season is not completed yet**

Current Season's Assists (GAA if goalie)

**Leave blank if season is not completed yet**

Current Season's Points (# of shutouts if goalie)

**Leave blank if season is not completed yet**

Experience Summary

Please give a brief summary of the player's hockey experience. E.g. Playing since age 6, made varsity team as 8th grader, best +/- on team for 2 years straight, etc...

Prep Schools and/or Colleges Interested In

Liability & Acceptance Waiver*

By checking this box, you accept and understand that Hockey Night in Boston will not assume responsibility for accidents and medical or dental expenses incurred as a result of participation in this program, and does not provide insurance coverage. Also, by submitting this form, you are confirming that you understand the refund policy. There are no refunds after May 15th, 2019. Refunds requested between April 1st, 2019 and May 15th, 2019 are subject to a $50.00 administrative fee. All refund requests must be sent either by email to hnibinfo@comcast.net, or in writing and sent to the HNIB office at 654 South Union St. #2, Lawrence, MA 01843.

I Accept

Registration Cost*

Price: $295.00

Payment Option*

Please choose a method of payment. Your registration will not complete until we receive either a check deposit, or you pay in full with a credit/debit card.

Pay by Check/Money Order
Pay by Credit/Debit Card

Total

$0.00

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Credit Card Payment*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

ATTENTION:

In order to complete your registration, you must make a deposit of $200.00, or pay the full amount by sending in a check or money order to the HNIB office at:
Hockey Night in Boston
654 South Union St. #2
Lawrence, MA 01843

ATTENTION:

If you do not see a submit button, that is because you need to check off the Liability & Acceptance Waiver. That section is located just above the Payment option section. Once you check "I Accept" the Submit button will become visible.

Register for the Boys Central/West H.S. Festival (6/21/19-6/23/19)

Player Information

Parent / Guardian Contact Information

Scholastic Information

ATTENTION:

Hockey Information

ATTENTION:

ATTENTION: