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Hockey Stars For Hope

Hockey Stars For Hope - Helping Kids Play

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Help A Kid Play Program Online Application Form

ALL fields are mandatory!
 
Child Info      
       
Name:     D.O.B.:    
Address:     Age:    
City:     Gender:    
Country:    

Special Medical and Nutritional Needs:
Postal/Zip:    

     
       
           

Parent/Guardian Info

      
           
Name &
Relation:		     Phone:    
Address:     Work:    
E-Mail:     Cell:    
Retype
E-Mail:		    

Yearly Income:

    
           
           

How did you hear about HSFH “Help A Kid Play" program?

 

    
           
Are you able to provide transportation back and forth to the rink for your child?
yes   no
           

If equipment is needed please provide:
Height: 

 

    
Weight:

 
Shoe Size:

 
           
       
 
   

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