PLAY FOR THE JR. BLUES

Prospective Player Questionnaire

Player First Name *

Player Last Name *

Street Address *

City *

State *

Zip Code *

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 Player For Name *

Last Season Played

Player's Height *

Player's Weight *

Player's Position *

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 # *

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?