Please do not leave blanks.
Form may not submit correctly unless all items are completed.
 

Information viewed and sent over the internet and stored on your computer can be viewed by others.  We do not provide a digitally secure means of submitting sensitive information.  If you are uncomfortable sending personal data electronically, then DO NOT  continue to the next step (Send).  Instead, print and mail this form or with permission, bring this form with you to tryouts.

Player Information

Name (Last, First)
 

Date of Birth

Street:

City:

 State/Province/Zip:

Player Home Phone,
include area code:

Player's Cell, include area code:
 

Place of Birth: 

Please estimate the following for the upcoming season:
Shirt size: Med Large (Default)
XL  XXL

Jacket size: Med Lg 
XL  XXL
(Default size is Large unless another size is selected)

Pant size: Med Lg
XL XXL
(Default size is Large unless another size is selected)

School Information

 School:

School, Street:
 
City/State/Zip:
 

Counselor/Advisor:

Advisor’s Phone:  

Grade next fall:

Graduation Year:

GPA: 
Class Size:     
Rank:

Previous Team Information

Position:

Shot : 
Left Right

Phone:

List the three teams you have played for and your stats (beginning with the most recent):

Team Name

Year

Games Played

Skater,

or Goalie

1.

Goals    Assists
  PIM

2.

Goals    Assists
   PIM

 Saves
  GAA
Save% 

3.

Goals    Assists
    PIM

 Saves
  GAA
Save% 

Other sports played?
If any

Current commitment to any school sport?
Athletic and citizenship honors and awards achieved:
 

In your opinion, what do you have to offer our program that will make a significant impact?

Who has contributed the most to your success as an athlete,
and why?

Why do you want to play for our organization?

Parent or Custodial Information

Father (complete contact information only if information differs from that of player):

Name: (First, Last):

Email:

Home Phone:

Father's Address - Street:

City/Sate/Zip:

Work or Cell:

Mother (complete contact information only if information differs from that of player):

Name: (First, Last):

Email:

Home Phone:

Address - Street:

City/Sate/Zip:

Work or Cell:

I am under the care of, check one: Both Parents    Mother Only    Father Only  
Custodial Care (If Custodian(s) complete the following:

Custodian’s Name(s): (First, Last):

Email:

Home Phone:

Address - Street:

City/Sate/Zip:

Work or Cell: