One Form Per Player - Personal Information
* are required.
Last Name:* First Name:*
Birthdate:*
/ /
YYYY MM DD
Gender:* Male Female
Street:* Apartment/Unit:
City:* Postal Code:*
Home Phone:*
Format: 613-555-5555
Email:*
Parent/Guardian 1:* Alternate Phone:*
Format: 613-555-5555
Parent/Guardian 2: Alternate Phone:
School:  
Programs and Registration Fees
Check all boxes that are applicable for this player.

House League Programs

Little Guys & Girls West Born 2004-2005
Cost $80 - Late Rate
Saturdays 8:00am - 9:00am at Bayridge S.S.
Novice Boys West Born 2002-2003
Cost $80 - Late Rate
Saturdays 9:00am - 10:30am at Bayridge S.S.
Novice Boys East Born 2002-2003
Cost $80 - Late Rate
Sundays 12:00pm - 1:30pm at LaSalle S.S.
Note: depending on interest this may be open to boys born in 2001 - please contact admin@kingstonimpact.ca if interested.
Novice Girls West Born 2001-2003
Cost $80 - Late Rate
Saturdays 3:00pm - 4:30pm at Bayridge S.S.
Novice Girls East Born 2001-2003
Cost $80 - Late Rate
Sundays 12:00pm - 1:30pm at LaSalle S.S.
Atom Boys Born 2000-2001
Cost $80 - Late Rate
Saturdays 10:30am - 12:00pm at Bayridge S.S.
Bantam Boys Born 1998-1999
Cost $80 - Late Rate
Saturdays 12:00pm - 1:30pm at Bayridge S.S.
Bantam Girls Born 1998-2000
Cost $80 - Late Rate
Saturdays 1:30pm - 3:00pm at Bayridge S.S.
Grad Girls Born 1995-1997
Cost $80 - Late Rate
Thursdays 6:30pm - 8:00pm/8:00pm - 9:30pm (alternate with boys) at Bayridge S.S.
Note: depending on enrollment, the girls/boys grad leagues may merge
Grad Boys Born 1995-1997
Cost $80 - Late Rate
Thursdays 6:30pm - 8:00pm/8:00pm - 9:30pm (alternate with girls) at Bayridge S.S.
Note: depending on enrollment, the girls/boys grad leagues may merge

In order to participate in the Kingston Impact Program, you must agree to all of the following legal notices.

REFUND POLICY
ACCEPTANCE OF TERMS AND CONDITIONS
I ACKNOWLEDGE MAKING THIS AGREEMENT

Do you agree that you, , are the parent or legal guardian of the player being registered and to be bound by this "Refund Policy", "Acceptance of Terms and Conditions" even if you have not read the agreements?

Yes No