2021-22 Little Flyers Juniors Questionnaire – Premier Orthopaedics IceWorks

Player Information

Player Level Selection

Player's Name*

First Last

Player's Home Address*

Street Address Address Line 2 City State ZIP Code

Player's Mobile Phone*

Player's Email*

Date of Birth*

MM

DD

YYYY

Height*

Weight*

High School*

Graduation Date*

MM

DD

YYYY

High School GPA*

Citizenship*

U.S. Citizen
Non-U.S. Citizen

Position*

Goalie
Forward
Defenseman

Shooting/Catching Hand*

Right Hand
Left Hand

Last Team You Played On*

Enter the name of the last team that you played on.

Coach's Name*

First Last

Coach's Phone*

Coach's Email*

Family Advisor

If you have a family advisor, please enter their name here:

First Last

Family Advisor's Phone

Family Advisor's Email

2019-2020 Stats

Please use the space provided to provide your 2019-2020 individual player statistics.
Please include: G, A, PTS, PIM's/GAA, SV%

Strengths

Please use the space provided to briefly describe your strengths as a player.

Weaknesses

Please use the space provided to briefly describe your weaknesses as a player.

Additional Information

Please use the space provided to add any additional information about yourself as a player that will be useful for us to consider.

Guardian Contact Information

Guardian's Name*

First Last

Guardian's Relationship to Player*

Other - Guardian Relationship

Please describe guardian's relationship to the player.

Guardian's Mobile Phone*

Guardian's Email*

3100 Dutton Mill Rd. Aston, PA 19014

(610) 497-2200

Open 7 Days / Week

Player Information

Guardian Contact Information

Public Skating

Normal Hours of Operation