Player Application

 

 

Name: ______________________________________

Address: _____________________________________________________________________

Phone: __________________________  Cell: ___________________

Email: _________________________________________ Height: _________ Weight: _______

Birth date: _______________GPA: __________ Class of: ________

Mother’s Name: ______________________________ Phone: ___________________________

Address: _____________________________________________________________________

Father’s Name _______________________________ Phone: ___________________________

Address: _____________________________________________________________________

Last Team: ____________________ Position: _______________2009-10 stats:_____________

Coach: _______________________ Phone_________________

Team: (circle one)          

Junior A             U-18 Midget AAA (Split Season)               U-16 Midget AAA (Split Season) 

Tryout Session: (circle one)

             Maine:        May 23                                   Halifax:        April 16 & 17

Send Application with check to:

Maine ($50.00)                                         Halifax ($125.00 cdn)

Maine Moose Hockey                                                            Halifax Gators

PO Box 422                                                                           c/o Denton White

Hallowell, ME 04347                                                             405 - 634 Parkland Drive

Fax: (207) 512-2146                                                              Halifax, NS, B3S 1N3

mainemoosehockey@hotmail.com                                     dcwhitehfx@yahoo.ca