Quake Tryouts - Online Application

Player Information (** Required)

First Name**:

Last Name**:

Parent Name(s)**:

Birth Date**:

/ /

Email Address:

Home Phone Number**:

Cell Phone Number:

Address**:

City**:

State**:

Zip Code**:

Height:

' "

Weight**:

Last Team:

Team Level:

Position:

Last Year Statistics:

GP:

PTS:

PIMS:

Waiver/Agreement: I acknowledge, agree and understand that there are risks inherent to the activities carried on the ice surface and other parts of the facility. I fully and knowingly assume all risks inherent to the activities carried on at the ice rink and all other parts of the facility and fully understand that said activities involve risks to the participants including bodily injury, partial or total disability, paralysis, death and damages that may arise therefrom.

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