2017-18maincamptryouts - League Athletics
2017-18 MAIN CAMP TRYOUTS APRIL 21ST-23 RD Hartford Jr. Wolfpack Hockey Organization United States Premier Hockey League (USPHL – Premier) Jr. A Tier III United States Premier Hockey League (USPHL – Elite) Jr. B
Player Info
Academic Info
Name:________________________________________
DOB:__________________
High School:____________________________________________
Street:________________________________________________________________ City:____________________________ Home Phone:____________________
State:_______
Zip:______________
Grad Year:___________ Rank:_______/_______ GPA:__________
Cell Phone:______________________ SAT:____________ ACT:________
Email Address:_________________________________________________________
TOEFL:____________
Parent’s Names:________________________________________________________
Our Host Team Hotel: Radisson 100 Berlin Road Cromwell, CT 06416 Please call Becky Plashett for reservations 860-635-2000.
Insurance Info: Health Insurance:_______________________________________________________ Policy Number:_________________________________________________________
Hockey Info Previous Team:_____________________________________________________________________________ Previous Coach:_________________________________________________________________ Position:_________________________
Ht:_________
Level:____________________________ Coaches Phone:________________________________________
Wt:___________
Shot/Catch:________________
2016-17 Statistics Forwards/ Defenseman
GP:________
G:_____ A:_____
P:_____
PIM:_______
Goaltenders
GP:_______
GAA:______
S%:______
Waiver UPON ENTERING EVENTS SPONSORED BY THE HARTFORD JR. W OLFPACK, I/W E AGREE TO ABIDE BY THE RULES OF USA HOCKEY. I/W E UNDERSTAND THAT PARTICIPATION IN THE SPORT OF HOCKEY CONSTITUTES A RISK OF SERIOUS INJURY INCLUDING PARALYSIS OR DEATH. I/W E VOLUNTARILY AND KNOWINGLY RECOGNIZE AND ASSUME THE RISK AND RELEASE THE HARTFORD JR. W OLFPACK, CHAMPIONS ARENA AND ITS AFFILIATE ORGANIZERS FROM ANY LIABILITY THEREFORE. ______________________________________ Date_________________ Player Signature
_______________________________________Date_______________ Parent Signature (If under 18 years of age)
Try–Out Fee Information: All players must mail in the following: Tryout Registration form and payment Fee: $150 and is NON REFUNDABLE. Copy of their 16-17 USA Hockey Registration Please make checks payable to: Consent to Treat Form Hartford Jr. Wolfpack 6 Progress Drive Half Shield Waiver Form Notarized; if Cromwell, CT 06416 applicable. Must be 18 or older Cell:(774) 286-0690 or Office:(860) 613-0385 *All forms are on website under Documents* CTAKE PRIDE IN THE PACK www.hartfordjrwolfpack.com .
Office Use Only: Cromwell, Payment CT 06416USA Hockey Reg Form Attn: Coach Cerrella
Consent to Treat Form
Reviewed
Player Info
Academic Info
Name:________________________________________
DOB:__________________
High School:____________________________________________
Street:________________________________________________________________ City:____________________________ Home Phone:____________________
State:_______
Zip:______________
Grad Year:___________ Rank:_______/_______ GPA:__________
Cell Phone:______________________ SAT:____________ ACT:________
Email Address:_________________________________________________________
TOEFL:____________
Parent’s Names:________________________________________________________
Our Host Team Hotel: Radisson 100 Berlin Road Cromwell, CT 06416 Please call Becky Plashett for reservations 860-635-2000.
Insurance Info: Health Insurance:_______________________________________________________ Policy Number:_________________________________________________________
Hockey Info Previous Team:_____________________________________________________________________________ Previous Coach:_________________________________________________________________ Position:_________________________
Ht:_________
Level:____________________________ Coaches Phone:________________________________________
Wt:___________
Shot/Catch:________________
2016-17 Statistics Forwards/ Defenseman
GP:________
G:_____ A:_____
P:_____
PIM:_______
Goaltenders
GP:_______
GAA:______
S%:______
Waiver UPON ENTERING EVENTS SPONSORED BY THE HARTFORD JR. W OLFPACK, I/W E AGREE TO ABIDE BY THE RULES OF USA HOCKEY. I/W E UNDERSTAND THAT PARTICIPATION IN THE SPORT OF HOCKEY CONSTITUTES A RISK OF SERIOUS INJURY INCLUDING PARALYSIS OR DEATH. I/W E VOLUNTARILY AND KNOWINGLY RECOGNIZE AND ASSUME THE RISK AND RELEASE THE HARTFORD JR. W OLFPACK, CHAMPIONS ARENA AND ITS AFFILIATE ORGANIZERS FROM ANY LIABILITY THEREFORE. ______________________________________ Date_________________ Player Signature
_______________________________________Date_______________ Parent Signature (If under 18 years of age)
Try–Out Fee Information: All players must mail in the following: Tryout Registration form and payment Fee: $150 and is NON REFUNDABLE. Copy of their 16-17 USA Hockey Registration Please make checks payable to: Consent to Treat Form Hartford Jr. Wolfpack 6 Progress Drive Half Shield Waiver Form Notarized; if Cromwell, CT 06416 applicable. Must be 18 or older Cell:(774) 286-0690 or Office:(860) 613-0385 *All forms are on website under Documents* CTAKE PRIDE IN THE PACK www.hartfordjrwolfpack.com .
Office Use Only: Cromwell, Payment CT 06416USA Hockey Reg Form Attn: Coach Cerrella
Consent to Treat Form
Reviewed
