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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 Goaltending
27 Brigantine Bay
Winnipeg, MB R3P 1R1

 

Contact/Emergency Information

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Address

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Parent or Guardian Name

Parent or Guardian Home Phone

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Doctor Name

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Program Information

 

Please select the program you are registering for

 

 

Personal Information

 

Goaltending Experience (years)

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Weight

Birth Date (YYMMDD)

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Goalie Shooter

 

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