Intake questionnaire
Player Development
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Age
What is your level of experience?
Never played but looking to start
Some but only for fun
Trying out for a team (recreation or competitive)
Currently on a team (recreation or competitive)
Trying out for a team (junior, university or professional)
Currently on a team (junior, university or professional)
What position(s) do you play?
How would you rate your basic ice-skating confidence?
Terrible
1
2
3
4
Expert
5
1 is Terrible, 5 is Expert
Have you previously worked with a development coach?
Yes
No
If yes to the above, what did you find worked well for you or didn't work for you about the process?
Camp/Session(s) Participation
Please only fill this in if you are registering for a camp or session(s).
Name of camp/session(s) you are attending
Date(s) of camp/session(s)
Location of camp/session(s)
Medicare number
Allergies that require an epi-pen
Emergency contact name
First Name
Last Name
Emergency contact number
Submit
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