EXPRESSION OF INTEREST - WORLD SKATE PARAGUAYFields marked with an * are required.error_outline Some fields contain errors Show {{form.showErrors ? 'Less' : 'More'}}keyboard_arrow_down {{error.field}} - {{error.message}} NameFirst NameLast NamePhone NumberPrimary EmailPrimary EmailSecondary EmailSecondary EmailAddressStreet AddressCityCountryDate of BirthGenderFemaleMaleEMERGENCY CONTACT INFORMATIONEmergency Contact #1First NameLast NameRelationshipPhoneWill this person be travelling with you?YESNOEmergency Contact #2First NameLast NameRelationshipPhoneWill this person be travelling with you?YESNOPARENT / GUARDIAN INFORMATIONONLY REQUIRED FOR ATHLETES UNDER 18.NameFirst NameLast NameEmailPhoneNameFirst NameLast NameEmailPhoneNATIONAL TEAM INTERESTWhich Program are you interested in?Jr Women's National TeamJr Men's National TeamSr Women's National TeamSr Men's National TeamWhich Positions do you play? Forward Defence GoaltenderShooting HandRightLeftHOCKEY EXPERIENCECurrent Inline Team(s)?Current Ice Hockey Team(s)?Highest Level of Inline Hockey Played?Highest Level of Ice Hockey Played?Years Playing inline Hockey?Years Playing Ice Hockey?Have you previously represented Canada?YESNOIf yes, when and what event?Have you participated in any of these events? NARCh Statewars Torhs AAU World Skate FIRS World Championships Provincial Championships National ChampionshipsAthletic Achievements you would like to share?COACH REFERENCESCurrent CoachFirst NameLast NameCoach Phone NumberCoach EmailAdditional Hockey Reference (OPTIONAL)AVAILABILITYAre you able to travel internationally if selected?YESNODo you currently hold a valid passport?YESNOMY PASSPORT IS BEING RENEWEDPassport Expiry DateMEDICAL INFORMATIONDo you have any medical conditions we should be aware of?Allergies?Dietary Restrictions?MEDIA AND PROMOTIONDo you consent to your image being used for Team Canada Promotional purposes?YESNOSOCIAL MEDIAInstagramOPTIONALFacebookOPTIONALTikTokOPTIONALX (Twitter)OPTIONALWHY TEAM CANADA?Why do you want to represent Canada?What do you believe you would bring to Team Canada?What are you goals for your hockey career?ADDITIONAL INFORMATIONDo you have any additional information you would like a selection committee to know?VIDEO SUBMISSIONOPTIONALOPTIONAL VIDEO SUBMISSIONPlease provide links to game footage or highlight videos.CommitmentIf selected, I understand participation may require: Attending Camps Following the Team Canada Code of Conduct Participating in fund-raising initiatives Meeting Payment Deadlines Representing Canada with INTEGRITY and SPORTSMANSHIP Understanding that selection is competitive and NOT GUARANTEED.STAY CONNECTEDWould you like to receive updates about: Team Canada Maple Nation Programs Coaching Opportunities Officiating Opportunities Development Camps International Tournaments CinicsPaymentDiscountSubtotalTaxTotal USDSubmitThe form has been submitted.
