Player Registration Form

LANSING CAPITALS

MIDGET AAA PROGRAM

__U16 Team _U18 Team   POSITION________ Shot L/R

NAME_____________________________________________________________________________

Nickname______________________ DOB: ___________________Height_________Weight________

ADDRESS___________________________________________________________________________

City____________________________________________ Postal Zip____________________________

HOME PHONE______________________________________________________________________

Player email___________________________________________________________________________

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Player Cell Phone______________________________ USA HOCKEY #________________________

Parent (1) NAME______________________________________________________________________

Address_______________________________________________________________________________

Email________________________________________________________________________________

Cell Phone___________________________________

Parent (2) NAME_______________________________________________________________________________

Address_______________________________________________________________________________

Email_________________________________________________________________________________

Cell Phone___________________________________

Emergency Contact_______________________________________ PHONE______________________

PLAYER  SCHOOL _________________ _________________________________________________

GPA______________________   ACT____________________________SAT_____________________

HOBBIES/other sports_________________________________________________________________

ALLERGIES__________________________________________________________________________

HOUSING NEEDS_____________________________________________________________________

SUMMER WORKOUT PROGRAM. _____________________________________________________

______________________________________________________________________________________

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