Police Check Rebate Form (Durham West Girls Hockey)

Police Check Rebate Form

Please complete the following form to be reimbursed for your police check.

Name:^*

Required

Address:^*

Required

City:^*

Required

Postal Code:^*

Required

Phone #:

Example: ###-###-####

Email:^*

Required

Team Name/Number/Colour: ^*

Required

Division:^*

Required

Peewee, Atom, etc

Method of payment for police check:^*

Required

Cost of Police Check:^*

Required

Photos, Word, & PDF Files Accepted.

Upload Receipt^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx.
Maximum # Files: 1. Maximum File Size: 4MB.