Bergen Catholic High School 1040 Oradell Avenue-Oradell,New Jersey 07649 -Ph (201) 261-1844 Fax (201) 599-9507 ON-Line Hockey Registration
INSTRUCTIONS:     1) FILL OUT ALL INFORMATION ON THE FORM  (** no blank fields allowed for student info **)     2) PRESS SUBMIT     3) CHECK STUDENTS OR MOTHERS EMAIL FOR CONFIRMATION     4) SEND CORRECTIONS TO REGISTRATION@BERGENCATHOLICHOCKEY.NET

1) STUDENT CONTACT INFORMATION
	Fist Name:		Grade:		Phone#:
	Last Name:			Cell#
	Address:
	City:		State:		zip:
	Student Email:				Class of:
	Birth Date:	Month: Day: Year:

2) PARENT CONTACT INFOMATION:
Mother's Information:
Name:		Phone#:		Cell#:
E-mail:
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Father's Information:
Name:		Phone#:		Cell#:
E-mail: