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   2006 St. Michael's Junior Buzzers Application Form

  • If you are interested in applying for the program please do so ASAP. The sooner that we can determine the need for additional teams, the greater chance it has of happening.
  • If you have any questions about the application process, please contact Kim White at kwhite@shipmsm.com or 1-888-746-4676 ext 334. Our fax number is 905-951-0265
  • Only those applicants that have been accepted into the program will be contacted. This will be done by March 15th, 2006.
  • Upon acceptance into the program a $250 deposit is required to secure your roster spot. Full payment is required by April 1st, 2006.
Player Information
Name:

Date of Birth:
Click to see calendar

Address:

City:

Province:

Postal Code:

Home Phone #:

Email:

SIN #:

Health Card #:

Current Team's Name:

Current Level:

Current Position:

Current Practice Time:

Your Father's Information
Name:

Work Phone #:

Cell Phone #:

Email:

Your Mother's Information
Name:

Work Phone #:

Cell Phone #:

Email:

Your 2004-2005 Coach's Information
Name:

Phone #:

Team Name:

Level:

Your 2003-2004 Coach's Information
Name:

Phone #:

Team Name:

Level:

Other Information
Do you attend St. Michaels College?

Have you attended our rookie camp?






 
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