Police Clearance Reimbursement Form (LaSalle Minor Hockey Association)

Police Clearance Reimbursement Form

First Name^*

Required

Last Name^*

Required

Phone Number^*

Required

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

Email Address^*

Required

Example: [email protected]. Your submission will be sent to this address.

Street Address^*

Required

City/Town^*

Required

Province^*

Required

Postal Code^*

Required

Please be sure that your scanned receipt is legible to avoid delays in reimbursement AND/OR rejection of your submission.

Upload police clearance receipt^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
Maximum # Files: 3. Maximum File Size: 4MB.