Colorado Warriors. Hockey Registration Form

Colorado Warriors. Hockey Registration Form

Please fill in the form below.
Requirements:
- Not Currently on Active Duty (you can apply if separation is within 3 months)
- 10% or greater disability rating from the VA
  Purple Heart
- Medically discharged from Active, reserves, or National Guard
- Veteran with disabilities that are the result of a disease or injury incurred or aggravated during active military service.
- Post-service disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service.
- A disability that did not occur during Military Service and meets discharge eligibility.
Basic Info
Player Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Birth Date *

Month Day Year
Status *

Single Engaged Married
Children? *
How Many, Ages
Spouse Name *

First Name Last Name
Spouse Birth Date *

Month Day Year
Military Info
Military Service *

Army (Active Duty, Reserve, National Guard) Navy (Active Duty, Reserve) Air Force (Active Duty, Reserve, National Guard) Marine Corps (Active Duty, Reserve) Coast Guard (Active Duty, Reserve)
Number of Years Served & Approx. Dates *
Units Served With: *
Rank *
Were You Discharged/Retired Under Honorable Conditions?: *

Yes No
Please Check All That Apply: *

I served honorably in a combat zone I served honorably during a time of conflict (but not in a combat zone) I served honorably during peacetime I am currently serving honorably
Briefly Describe Your MOS: *
Disability Info
Disability *

I have a physical disability as a result of serving in any capacity I have a mental disability as a result of serving in any capacity
Do You Currently Have Any Of The Following: (Please Check All That Apply): *

10% or greater disability rating from the VA Purple Heart Medically discharged from Active, reserves, or National Guard Veteran with disabilities that are the result of a disease or injury incurred or aggravated during active military service Post-service disabilities that are considered related or secondary to disabilities occurring in service and for disabilities presumed to be related to circumstances of military service, even though they may arise after service. A disability that did not occur during Military Service and meets discharge eligibility.
Have You Ever Had, Or Do You Have Now, Any Injury Or Condition That You Feel May Prevent You From Participating In Hockey? *

Yes No Not Sure
Do You Feel That You Are In Good Health? *

Yes No
Do You Feel That You Are In Adequate Enough Physical Shape To Participate In Colorado Warriors Hockey Club Practices and Games? *

Yes No
Do You Have Transportation To/From Colorado Warriors Hockey Practices and Local Games? *

Yes No
Hockey Info
Please Select The Statement That Best Describes Your Hockey Experience: *

I am a beginner (little or no experience skating or playing hockey) I am an intermediate (able to skate, played youth or recreational hockey) I am a skilled player (played competitive through bantam, AA, College club) I am an advanced player ( AAA, Junior, College, Semi Pro, Pro)
On A Scale Of 1-10, 1 being (I Can't Skate) and 10 being (Pro Level), Describe Your Skating Ability: *

1 - Can't Skate 2 3 4 5 - Intermediate Level 6 7 8 9 10 - Pro Level
Which Position Would You Like to Play Most? *

Forward Defense Goaltender Coach Equipment Manager
Please List (3) Desired Choices For Jersey Number (in preference order):
Jersey Size *

Small Medium Large XL XXL XXXL
Helmet Size *

Small Medium Large XL XXL XXXL
Glove Size *

12" 13" 14" 15" 16"
Breezer Shell Size *

Small Medium Large XL XXL
Shirt Size *

Small Medium Large XL XXL XXXL
Warmup Jacket Size *

Small Medium Large XL XXL XXXL
Warmup Pants Size *

Small Medium Large XL XXL XXXL
Do You Have Your Own Hockey Equipment? *

Yes No I have some, but not all
Admin Info
Have You Registered With USA Hockey? *

Yes No
Do You Have Family or Friends Who Are Interested In Volunteering With The Colorado Warriors Hockey Club Program, In Any Capacity? *

Yes No
I certify that the information I have provided on this registration is true to the best of my knowledge. I also acknowledge that participating in the USA Hockey Warriors program is "at my own risk” and Colorado Warriors Hockey Club will not be held responsible for any injury or illness incurred while participating in a Colorado Warriors Hockey Club event
I Agree With The Above Statement

I Agree
I certify that I have registered with USA Hockey, or that I intend to prior to participating in my first on-ice practice
I Agree With The Above Statement

I Agree
I understand that any equipment I sign for is the property of Colorado Warriors Hockey Club and that any equipment not returned will be compensated for at my expense
I Agree With The Above Statement

I Agree
I understand that Colorado Warriors Hockey Club is a registered 501c3 nonprofit veteran organization and in no way shall the name Colorado Warriors Hockey Club be used for personal gain
I Agree With The Above Statement

I Agree
Questions or comments
Should be Empty:

Colorado Warriors. Hockey Registration Form

Basic Info

Military Info

Disability Info

Hockey Info

Admin Info