REGISTRATION

fill out the form below to register

Participant's Name*
First Last
Parent's Name*
First Last
Date of Birth
Address
Street Address Address Line 2 City Province Postal Code
Home Phone
Cell Phone
Email*
By providing your email you are agreeing to let Canadian Ice Academy contact you with news and updates.
Select Your Program
Select Your Option
- 1 class / week ($26.00)
- 2 class / week ($52.00)
- Full week Option ($124.00)
- Full week Option ($124.00)
- Full week Both ($248.00)
Grade
Current Team
Level
Position
Program Apparel Sizing
Jersey
Socks
Hoodie
T-shirt
Shorts
Select Your Class
- Beginner Class
- Advanced Class
Choose Your Level
Goalie
- Yes
- No
Skate Canada #
Home Club:
Coaches Name:
Competition Level:
Test Level (if applicable)
Membership Option
Select your days & time
- Friday 6:00 PM
- Saturday 9:30 AM
- Sunday 12:00 PM
Skate Canada annual fee
- I already paid my Skate Canada annual fee
- I haven't paid my Skate Canada annual fee
CanSkate # (if applicable)
Policies Agreement
- By checking this box you agree to the terms on the policies page

3111 Universal Drive Mississauga, ON

905-625-7528