2010 / 2011 Registration Form
2010/2011 Tryout Registration
Please fill out... cost of each session is $30.00
Name:_____________________________________ Date of Birth:______________________
Address:___________________________________ Phone No.:________________________
E-mail :_____________________________________________________________________
Parents / Guardians Names:_____________________________________________________
Current Association / Last Team
Association:__________________________________ Team:_________________________
Coach:_______________________________ Coach Phone: _________________________
Player Profile
Position:_____________________ Ht:_________ Wt:________ Shot: R / L (circle one)
Current Stats: Games:____ Goals:____ Assists:____ PIMS:____ Save %:____ GAA:____
Last Years Team:____________________ Spring / Summer Team:_____________________
Last Year Stats: Games:____ Goals:____ Assists:____ PIMS:____ Save %:____ GAA:____
School Information
High School:_________________________ Address:________________________________
Grade:___________ GPA:______________________________________________________
Medical History and Medications:__________________________________________________
Health Insurance Provider:_______________________________ Policy No: _______________
USA Hockey # ________________________________________
I agree to abide by all rules and policies of the Jamestown Jets and I will hold myself accountable to the Jets staff
and other participants and the arena.
Player Signature:__________________________ Parent Signature (if not 18)____________________________
Date: _______________________________ Date:___________________________________
Jamestown Jets Junior Hockey
319 West 3rd Street
Jamestown, NY 14701
Jets Hockey Office: 716-484-8167
Email: dcanfield@jamestownjets.com
www.jamestownjets.com
