Click here for the printable version of 2012 Player Registration Form.

Thank You!
 
REGISTRATION FEE: $350 (if postmarked by 1/31/12. Registrations postmarked after this date is $375.)
SIBLING DISCOUNT: Registration fee is reduced by $100 for the 2nd child, 3rd child is free.
REFFERAL BONUS: Refer a new player to the Rockers program and receive $75 off your registration fee.

Any player experiencing financial difficulties in paying the player fee may contact Martin Bednarek, Executive Director at (267) 798 5858 for assistance. All calls are confidential.

*  - required field
** - required one of them

2012 Player Registration Form

Name*:
D.O.B*:
Current Grade*:
Address*:
City*:
State:
ZIP*:
Home Phone**#:
Cell**#:
Primary E-mail*:
Secondary E-mail:
School*:
High School Team Level:
CYO and/or Winter League Team:
Parent(s)/ Guardian(s)*:
Insurance Carrier*:
Medical Problems:
Adult Uniform Size*:
Position Played:
 
   

 

 

  
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