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Fall 2008 3-on-3 Waiting List

Please fill in the following information to be added to the waiting list.

Player Information

First Name: *

Last Name: *

Birth Year: *

Address 1: *

Address 2:

City: *

State: *

Postal Code: *

Name of Parent/Guardian: *

2008/09 Team/Playing Level: *

Phone Number: *

Be sure to include your area code (123-123-1234)

Email Address: *

Optional Note for Special Needs/Other:

Program Details

Select Appropriate Division: *

Bantam Gold (A level only)

Bantam Silver (B/C level)

PeeWee Gold (A level only)

PeeWee Silver (B/C level)

Girls U12

Squirt Gold (A level only)

Squirt Silver (B/C level)

Girls U10

Mite Gold (highest level mites)

Mite Silver (3+ years experience)

Hockey Development Center
20775 Holt Avenue
Lakeville, MN 55044
Phone: (952)-469-2218