Grundy Senators Ice Hockey Org Evaluations Squirt and PeeWee 2020/2021 Season

Player First Name

Player Last Name

Player Birth Date

Month Day Year

USA Hockey NUMBER

Level you are evaluating for

Team(s) Last Season

Level played last season

Position Played

Forward, Defense, Either, Goalie

Have you evaluated for any other team for the 2020/21 Hockey Season

Yes or No

Father's Name

Parent Contact Phone Number

Area Code Phone Number

Parent Contact E-mail

Mother's Name

Parent Contact Phone Number

Area Code Phone Number

Parent Contact Email

example@example.com

Parent Contact Email

Street Address

City

State

Zip Code

Jersey Number

Referred By

Please provide the players name who referred you to the Senators Organization

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