Senior Registration Form (2):

First name:
Surname:
Players DOB (dd/mm/yyyy):
Primary email (game info):
Primary phone (txt game info):
Male or Female:	Select... M F
# previous years played:	Select... New 1 2 3 4 5+
Select grade:	Senior MenSenior Women
Emergency contact (name / ph):
Additional information:
I give permission for photos of me to be posted to the Pukekohe United Hockey Club website or to the PUHC facebook page. PUHC will not include any names and will not tag them in any pictures.

Note: One form per player and a copy email including all this information will be forwarded upon the clicking of the submit button.