Form133 - Application For Player Movement printable pdf download

Pacific Coast Amateur Hockey Association

Form133

(Rev: June/09)

APPLICATION FOR PLAYER MOVEMENT

PCAHA CENTRAL OFFICE: #114-3993 HENNING DRIVE, BURNABY, B.C., V5C 6P7

Phone: 604-205-9011.

Fax: 604-205-9016.

Player Movement into and within the Pacific Coast Amateur Hockey Association (PCAHA) is governed by the PCAHA Rules and Regulations. No player

may change Association registration except in accordance with the PCAHA Rules and Regulations. (Copies of the applicable Rules and Regulations will be

provided upon request).

This Application must be filled out completely and accurately prior to submission to the PCAHA Office. An incomplete or

inaccurate Application will not be considered. No player movement has effect until the PCAHA Player Movement Committee has granted approval.

Player’s First Name:

Player’s Last Name:

Hockey ID #:

Date of Birth:

PLAYER’S PARENTS’ PERMANENT PLACE OF RESIDENCE

Parents’ Residence:

City:

Postal Code:

Date of Occupancy at this Address:

Telephone:

PLAYER’S PARENTS’ FORMER PLACE OF RESIDENCE (Complete if Residential Move/change of residence)

Player’s Parents’ Former Address:

City:

Postal Code:

Number of Years at Old Address:

Telephone:

HOCKEY HISTORY (Please Complete)

SEASON

AGE

ASSOCIATION

DIVISION

“A” “B” “C”

2008-2009

2007-2008

2006-2007

2005-2006

2004-2005

2003-2004

2002-2003

Reason For Application:

I/we hereby declare and certify that all information contained in this form is true and that the Parents’ Address

DECLARATION:

given above is the permanent family place of residence. Further, we agree to abide by the Constitution, By-Laws, Rules, and

Regulations of the Pacific Coast Amateur Hockey Association (PCAHA), BC Hockey, and Hockey Canada, and recognize that

failure to abide by the Constitution, By-Laws, Rules, and Regulations of the PCAHA, BC Hockey, and/or Hockey Canada,

including submission of any false registration information, shall cause the individuals responsible to be subject to suspension

and/or other disciplinary action.

PLAYER’S SIGNATURE:

MOTHER’S SIGNATURE:

(Print Name):

DATE:

FATHER’S SIGNATURE:

(Day)

(Month)

(Year)

(Print Name):

PLAYER’S PRESENT ASSOCIATION

PROPOSED NEW ASSOCIATION

Association:

DECLARATION: I/We have considered the information provided above

and agree that this player movement is in accordance with the PCAHA

and have verified that this proposed player movement is in accordance

Rules and Regulations. Accordingly, I/we hereby grant the named player a

with the PCAHA Rules and Regulations. Accordingly, I/we hereby accept

RELEASE. (President, Registrar, or Vice-President must sign).

the player’s registration. (President, Registrar, or Vice-President must

sign).

Name:

Title:

Date:

Title:

Date:

Signature:

Form133 - Application For Player Movement

Related Articles

Related forms

Related Categories