5221

TRY OUT FORM

2021-2022 season

Name and first name : ____________________________________________________________

Address: ______________________________________________________________________
City: ________________________________ Postal code: _______________________________
Telephone number: ( ) _____________________________________________________
Cellular number: ( ) _______________________________________________________
E-mail address: _________________________________________________________________
Date of birth: ___________________________________________________________________
Place of birth: __________________________________________________________________
Social Insurance Number: _________________________________________________________
Health Insurance Number: ________________________________________________________
Name of the player’s father: _______________________________________________________

POSITION: Goalie ______ R.D. _______ L.D. ______ R.W. ______ L.W. ______ C. ______
HEIGHT : ___________ feet _____________ inches WEIGHT : _______________ pounds

Name and division of the last team in which the player played: ___________________________

______________________________________________________________________________

By signing this try out form, the player recognizes that the __________________ team, member
of the Quebec Major Junior Hockey League, can inscribe his name on the team’s protected list.

______________________________ _______________________________________
Date Player’s signature

OBLIGATORY (if under age) _______________________________________

Parental authority signature

_______________________________ _______________________________________
Date Signature of the Major Junior team’s
manager or the authorised person

Each team is allowed a maximum of TWENTY (20) TRY OUT FORMS to place a player on his
protected list. These forms can be used following the Entry draft up until the day before the beginning
of the regular calendar.