MINI-PREDS AND PEE-WEE PREDS
REGISTRATION FORM
October 2010 TO December, 2010
This is a registration for the mini and pee-wee Preds. If you would like to register, please submit a payment for $100.
Name:
Address:
City:
Phone #:
Birthdate:
MONTH January February March April May June July August Setpember October November December DAY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2001 2002 2003 2004 2005
Postal Code:
Gender:
Entering Grade:
Male Female
Enter Grade SK 1 2 3 4 5
E-mail Address:
Parents' Names:
Emergency Contact:
Emergency Contact Phone #:
Kitchener Waterloo Predators Volleyball Club 303 Misty Cres. Kitchener, N2B3V4
Make Cheque Payable to "Kitchener -Waterloo Predators"
Questions can be directed to Stephen Green at 519-404-3757
Select a Tshirt Size Youth Extra Small Youth Small Youth Medium Youth Large Youth X-Large Small Medium Large X-Large