Participants Hockey Canada ID #? *

LAST Name of Participant *

Enter LAST name that matches in Hockey Canada

FIRST Name of Participant *

Enter FIRST name that matches in Hockey Canada

Birthdate of Participant *

YYYY-MONTH-DAY

What program is the participant withdrawing from? *

What position is the participant registered in? *

Is the participant a member of the Tsuut'ina Nation? *

Reason for the withdrawal? *

Name of the person requesting the withdrawal? *

Email Address to receive confirmation of withdrawal? *

Relationship to the member of the person requesting the withdrawal? *

I have read and agree to the refund policy? *

The refund policy can be found on the website

The date the form is submitted is used as per the refund policy *

Please verify that you are a human.