2012 Belle Tire Registration Form

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* 1. Player's Name

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* 2. Parent/Guardian's Name

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* 3. Parent/Guardian's Email

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* 4. Parent/Guardian's Phone (optional)

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* 5. Player's Home Address

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* 6. What district does the player live in?

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* 7. For what team(s) did the play previously play?

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* 8. Team Position Desired

Forward

Defense

Goalie

Any Position

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* 9. Birth Date

Date

Date

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* 10. What is your long-term hockey goal?