Hockey Coach & Asst Coach application

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Join us in providing ALL Metro Chicago youth the opportunity to experience the thrill of participating in ice sports in a fun, safe, positive and inclusive environment regardless of race, color, religion, national origin, gender and socio-economic status.

Email *

First Name *

Last Name *

Gender *

Female

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Other:

Date of Birth

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Marital Status *

Single

Married

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Other:

Street Address *

Apt, Suite, Building Number

City *

State (example: IL) *

Postal/Zip Code (5 digit) *

Cell Phone (format: 312-555-5555) *

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EMERGENCY CONTACT INFO

Please provide information on who you'd like us to contact in case of an emergency.

Emergency Contact Name (first and last) *

Emergency Contact Phone Number (format: 312-555-5555) *

Emergency Contact relation to you *

Parent/Gaurdian

Spouse

Friend

Other:

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