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Player Name *

Birthdate *

Address *

Parent Name *

Parent Phone Number *

Email Address *

Grade and School *

Number of years of club level experience *

Jersey Number (1-39) not a guarantee. Please select 3 *

If child qualifies for a Select Team can you/she make the commitment:

If child qualifies for a Nationals Team can you/she make the commitment:

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Thank you for completing this form. We will see you at Tryouts. November 14 & 15

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