EmailMe Form - GLOBAL PROSPECT ADVANCEMENT *Powered by QHP

PLAYER'S NAME

First Last

BIRTHDATE

MM / DD / YYYY

Height (Feet ex. 6.01)

Weight (LBS)

POSITION

FORWARD

DEFENSE

GOALIE

LEVEL PLAYED 2018/19

TEAM PLAYED 2018/19

PLAYER'S EMAIL

PLAYER'S CELL PHONE

### - ### - ####

MOTHER'S NAME

First Last

MOTHER'S EMAIL

MOTHER'S CELL PHONE

### - ### - ####

FATHER'S NAME

First Last

FATHER'S EMAIL

FATHER'S CELL PHONE

### - ### - ####

Please attach any Medical Conditions and /or previous injuries our trainer should know about.

Cancellation Policy: No Refund
The above applicant will not hold the owners and staff of QUEBEC HOCKEY PROSPECT liable/responsible for damages, loss or injury which may occur and hereby release QUEBEC HOCKEY PROSPECT from any action which may occur while attending the QUEBEC HOCKEY PROSPECT EVENTS. This release covers traveling to and from the arena as well as any all activities on and off the ice.