Contact Information

* First Name:

* Last Name:

* Gender:

* Date of birth:

* Address:

* City:

* Postal Code:
(ex: A1B2C3)

* E-Mail Address:

Alternate E-Mail Address:

* Phone:

Cell:

* Position:

* Last team played for:

Mother:

Father:

Programs

Upon selection of your date of birth, appropriate programs will be made available.

Registration and Payment Requirements

* Please note that registration alone does not secure your spot. It must be accompanied with your payment for the desired programming sessions.

Send cash or cheque payable to:

Laker Hockey Academy
52 Bridgetown Dr, Winnipeg, MB, R3X 2J8

-OR-

Send e-Tranfer to:
lakerhockeyacademy@hotmail.com

* Successful registration should be accompanied by auto-generated e-mail immediately following online registration. If you do not receive this e-mail within 5-10 minutes of online registration, check your junk/spam folder. Otherwise, please e-mail info@lakerhockeyacademy.ca. This is in regards to e-mail possibly being blocked by spam filters, or directed to your junk/spam folder.

Laker Hockey Academy

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