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Complete registration form to become a member of Parahockey Quebec

Basic Information

First Name Your first name as it appears on official documents

Last Name Your last name as it appears on official documents

Date of Birth

Format: YYYY-MM-DD (e.g., 1995-03-15)

Gender

Male

Female

Other

Address

Street Address

City

Province

Postal Code

Contact Information

Phone Number

Mobile

Other

Email

Registration Type

Junior
For young players

Development
To learn and progress

Elite
For experienced players

Coach
To manage the teams

Volunteer
To help the organization

Practice Registration & Pricing

Catégorie de pratique

Décharges obligatoires

Veuillez lire et accepter les décharges suivantes pour compléter votre inscription.

Progression des décharges 0 / 9

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Hockey Québec

PracticeWaivers_ValidationRequired

Parent/Guardian Information

Parent/Guardian Details

First Name

Last Name

Parent Type

Phone Number

Email

Second Parent/Guardian Details

First Name

Last Name

Parent Type

Phone Number

Email

Emergency Contact Information

Emergency Contact Details

First Name

Last Name

Relationship to Member

Phone Number

Email

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