2013-2014 Little Rocker Curling Registration Form

Registration fee: $70.00

Time: Saturday 10:00 am

Curler Data:

Name:__________________________

Address:___________________________

Phone:_____________

Birth Date:

Day:_____

Month:_________

Year:_______

Age as of December 31,2013______

Parents Names:

Father______________

Mother______________

Curling Experience

Number of Seasons____

Team Formation: (Leave blank if you wish to be placed onto a team.)

I would like to curl with
______________________	______________________	_____________________

Method of payment:

Cash_____

Cheque_______

Date Paid__________________

Parent Signature:_______________________