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Player's name
Age
Parent's name (if minor)
Division
Bronze - entry level
Silver B
Silver A
Gold B
Gold A - most experienced
Adult league team name
Describe your level of play:
Adult beginner
Adult hockey class
Adult league
Youth beginner
Youth hockey class
Youth league
What skills would you like to work on during your lesson(s)?
I would like to work on my skating skills only (no stick/puck)
No
Yes
Email
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Area Code
Phone Number
Evening Phone
Area Code
Phone Number
Best day(s) & time(s) for lesson
Length of lesson requested
15 min
30 min
45 min
60 min
How many lessons are you interested in?
One time only
Weekly
Occasionally
Private ice time for team that has been reserved
Instructor preference, if any
Would you like to request your group class instructor?
Yes
No