Form cover
Page 1 of 2

2026 Empower Summer Programs Registration

Parent Email

Join Our Mailing List!

Join Our Mailing List!

Parent First Name

Parent Last Name

Athlete First Name

Athlete Last Name

Athlete Birth Year

Select Your Age Group:

Subtotal = $

GST 5% = $

Grand Total = $

Are you new to Empower Hockey?

Are you new to Empower Hockey?
A
B

Emergency Contact First & Last Name

Emergency Contact Phone Number

Comments