PLAY FOR THE JR. BLUES

Prospective Player Questionnaire

Player's First Name *

Player's Last Name *

Player's Birthdate *

Street Address *

Street Address (Additional Information)

City *

State *

Zip Code *

Player's Home Phone #

Player's Cell Phone # *

Player's Email Address *

Parent's Name (1) *

Parent's Cell Phone # (1) *

Parent's Email Address (1) *

Parent's Name (2) *

Parent's Cell Phone # (2) *

Parent's Email Address (2) *

Last Team Played For Name *

Last League Played For Name *

Last Season Played *

Player's Height *

Player's Weight *

Shoots *

Last Season Played Player Statistics (G, A, PTS, PIMS)

Last Season Played Goalie Statistics (W-L-T, GAA, SV%)

Last Season Played Head Coach Name *

Last Season Played Head Coach Phone # *

Last Season Played Head Coach Email Address *

Elite Prospects Profile URL Link (If available)

High School Name: *

GPA, ACT/SAT Score (If Taken) *

What do you see as your goals in hockey? *

Why do you want to play for the St. Louis Jr. Blues? *