BCHL Credit Card Payment Form (Brantford Community Hockey League)

Print BCHL Credit Card Payment Form

Please complete this form if you wish to pay for your registration fees by Credit Card. Alternately, you can pay by ETRANSFER to [email protected] - PLEASE INCLUDE PLAYERS NAME IN THE MESSAGE PORTION OF THE EMAIL TRANSFER. ***THIS IS A SECURE FORM AND INFORMATION WILL NOT BE SHARED OR SAVED***

Player Information

Player Name^*

First and Last Name

Date of Birth^*

Open the calendar popup.

Contact Information

Name of Parent or Guardian^*

First and Last Name
Main Phone Number^*

eg. ###-###-####
Email Address^*

You will NOT receive confirmation of this form for security of personal information..

Payment Information

Select all items you are submitting payment for

Select Division Fee^*
Little Saints $160
U6 and U7 Tyke $400.00
U8 and U9 Novice $400.00
U10 and U11 Atom $475.00
U12 and U13 Peewee $475.00
U14 and U15 Bantam $475.00
U16 to U21 MID/JUV $375.00
ALL GOALIES $100.00
Check All That Apply
Card Type^*
VISAMASTERCARD
Card Number^*
Expiry Date^*
Are you paying for multiple players?

List names of all players you are making payments for

Human Validation

Check The Box ^*

BCHL Credit Card Payment Form (Brantford Community Hockey League)

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