PLAYER PROFILE FORM


Last Name:
    First Name:    MI:  

Address:      
 
City:        
 
     State/Prov:  
    Zip:   

Country:       Citizen: 

Date of Birth:    (enter with slashes   mm/dd/yyyy)

Home Phone:           Parent Cell#:             

Parent/Guardian    First Name:    Last Name:   

E-Mail Address:      
 
Alternate E-Mail      

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Primary Position: Forward      Defense   Goaltender                         Shot / Catch:   Right      Left

School Grade:     School GPA:     ACT:     SAT:  

Current Team:         Current Coach:         

Coaches Phone:     Coaches E-Mail Address:     

 Other Hockey References:       

______________________________________________________________________

If selected, I am available to attend the Riga, Latvia, July 29 - August 6, 2012?    YES    NO

______________________________________________________________________

Strength as a Hockey Player:


Who is the best player you played against this season and which team does he play for:
Player
:         Team:   
   

Preferred Jersey Number (please pick three):                                                             

Jersey Size:   Youth Small     Youth Medium    Youth Large
               
Adult Small     Adult Medium    Adult Large      Adult X-Large     Adult 2X-Large