INDIVIDUAL STREET HOCKEY APPLICATION
NAME________________________________DATE OF BIRTH_______
ADDRESS__________________________CITY____________________
STATE_____ZIP______HOME PHONE #__________________________
CELL NUMBER__________________WORK #______________________
E-MAIL ADDRESS_____________________________________________
ABILITY LEVEL
PLEASE MARK ONE
A_______
B_______
C________
This application is to indicate to Hockeytown USA, Inc. as well as their Street Hockey teams that you would like to be placed on a new or existing team. By filling out and signing this application you are giving consent to have your contact information be posted at Hockeytown USA, Inc. as well as on Hockeytown USA’s website. By giving this information you are also allowing individual street hockey team managers, captains or players the right to contact you directly.
SIGNATURE_____________________________________DATE__________________