Upon receipt of this form, a program itinerary will be emailed to you...
Please mail payment in full to:
The Rick St. Croix School of Goaltending27 Brigantine BayWinnipeg, MB R3P 1R1
Contact/Emergency Information
Name
Address
City, Province/State
Postal/Zip Code
Parent or Guardian Name
Parent or Guardian Home Phone
Work or Emergency Number
EMail Address
Confirm EMail Address
Doctor Name
Doctor Phone Number
Allergies/Medical Conditions/Notes
Medical #
PIN #
Program Information
Please select the program you are registering for
Gateway(Wpg)-4day(Apr7,9,14,16) Scwhans(Marshall)-4day(Jun16-19) Scwhans(Blaine)-4day(Jun22-25) Runestone(Alexandria)-4day(July21-24) Tournament Center(Thunder Bay)-4day(Aug5-9) Tournament Center(Thunder Bay)-5day(Aug5-9) Dutton(Wpg)-5day(Aug12-16) Varsity(Wpg)-4day(Aug19-22) Varsity(Wpg)-5 day(Aug-25-29) Maples(Wpg)-5day Ice Only(Sept5-9) Schwans(Blaine)-3day(Sept12-14) Clipper(Niverville)-3day(Oct10-12) Englestad(Thief River Falls)-3day(Oct16-18) TournamentCenter(Thunder Bay)-3day(DecTBA) Maples(Wpg)-3day(Dec29-31)
Personal Information
Goaltending Experience (years)
Height
Weight
Birth Date (YYMMDD)
Male Female
Goalie Shooter
