Northern Alberta Xtreme
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Prospects
Evaluation Camp Application
Please fill out the form below to register for the 2019/2020 Season
A payment of $200.00 is required upon sign up.
Evaluation Camp Application
Player's Information
First Name
*
Middle Name
Last Name
*
Address
*
City/Town
*
Province/Territory
*
Postal Code
*
Email Address
*
Phone Number
Date of Birth
*
Level & Division
Position
Goals (Previous Season)
Assists (Previous Season)
Pims (Previous Season)
Shoots
Right
Left
Catches
Right
Left
N/A
Parent First Name
*
Parent Middle Name
Parent Last Name
*
Parent Phone Number
Emergency Information
Emergency Contact Name
*
Emergency Contact Number
*
Doctor First Name
Doctor Last Name
Doctor Phone Number
Alberta Health Care Number
Allergies or Health Concerns
Paypal Account Email
*