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Blaze Youth Summer League - 2021 Registration Form
Youth Program April thru September 2021 • 20 Sessions for only $275 • Greenheck Ice Arena • Schofield
Goalie Program May thru September 2021 • 18 Sessions for only $300 • Greenheck Ice Arena • Schofield
Email *
Player's Full Name *
Player's Mailing Address *
Please include city and zip code
Player's Birth Date *
Male or Female *
Player's Home Team
I am a Goalie looking to play in the youth program
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2021 Blaze Registration Level *
If between age groups you can play up or down
Player's T-Shirt Size
Youth Size
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Adult Size
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Medications, Medical Limitations, and/or Allergies:
Please List
Parent/Guardian Details
Full Name #1 *
Full Name #2 *
Address (if different from player's)
Home Phone
Cell #1 *
Cell #2
Email Address #1 *
Email Address #2
Emergency Contact Name / Relationship to Player
Home Phone
Would you like to occationally help supervise on the ice. Looking for Coaching help at each of the youth Levels.
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