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*
Player's Name:
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Parent's
Name:
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School
District:
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HS
graduation year:
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Address:
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City:
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Zip
Code:
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*
Phone:
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Cell
Phone:
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*
Email
address:
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If no email enter "None"
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*
Birthday:
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Age:
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Years
of experience:
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Roller
Ice
Both
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Full-time Goaltender?:
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Yes
No
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Requested coach or teammate:
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(We will try to
honor any request if possible)
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Did
someone refer you to our league?
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(Please list the person who referred you to our
program, if
applicable)
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*
Please
select an age
division:
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Please check here if you are
interested in helping to
sponsor a team:
Yes
No
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Please check here if you are
interested in:
Coach
Assistant
Coach
Referee
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Please check
which session you are signing up for:
Fall
Session Winter
Session
Full
Season Spring
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When you click on the
Register Button, you will be directed to
another
web site to complete the form. Please follow the instructions to
complete the registration process.
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