Churchill Hockey Academy  - Contact List                                         2022/23
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Email *
Student's Name   (Surname, Given Name) *
Student's Birthday (MM/DD/YYYY) *
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DD
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YYYY
Gender *
In what community do you reside? *
What school are you attending presently? *
What is your hockey playing experience? *
What type of player are you? *
Which program applies to you? *
Parent Contact Information (Surname, Given) *
Contact Phone Number  *
A copy of your responses will be emailed to the address you provided.
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