Selkirk Steelers


*REGISTRATION FORM - August Fall CAMP 2008*

NAME:
DATE OF BIRTH: MM DD YY
ADDRESS City/town and Postal Code:
POSTAL CODE:
PHONE NUMBER:
CELL NUMBER:
FAX NUMBER:
Grade:
Clearing House #:
SAT SCORE:
PARENT/GUARDIAN Mother and Father:
E-MAIL:
2007/08 team:
POSITION:
Level:
HEIGHT:
WEIGHT lbs:
9 DIGIT MEDICAL NUMBER:
Other MEDICAL NUMBER:
Blue Cross Group or Plan:
Allergies:
Medications:


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  2006 Selkirk Steelers - All Rights Reserved

1011 Manitoba Avenue, Selkirk, MB, R1A 3T7   *   Tel: (204) 482-7020   *    Fax: (204) 482-7106
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Tuesday, September 16 2008 | 6:23:50 PM