Goalie Clinic - U11 (Feb. 23 @ 12:30) (Red Circle Hockey Club)

Goalie Clinic - U11 (Feb. 23 @ 12:30)

Player Full Name^*

Required

Birth Day (mm/dd/yyyy)^*

Required

Guardian Full Name^*

Required

Guardian #1 Phone Number^*

Required

Example: ###-###-####

Guardian #1 Email Address^*

Required

Example: [email protected]. Your submission will be sent to this address.

In an emergency, when parents cannot be reached, please contact:

Primary Emergency Contact First Name:^*

Required

Primary Emergency Contact Last Name:^*

Required

Primary Emergency Contact Relationship to Player:^*

Required

Primary Emergency Contact Phone #:^*

Required

Example: ###-###-####

Does the player have allergies or medical conditions that we need to be aware of?^*

YesNo

Required

If yes, please list or mark N/A^*

Required