Ed Snider Youth Hockey & Education

PLEASE COMPLETE AND SUBMIT THIS FORM ONLY ONCE
Student Information
Student First Name*
Student Last Name*
Student Sex*
Student Date of Birth*
Student Race/Ethnicity*
Do you live in Philadelphia?*
Street Address*
City*
State*
Zip Code*
Student's Current School*
Student's Current Grade*
Parent/Guardian Information
Parent/Guardian Name*
Parent/Guardian Phone Number*
Parent/Guardian Alternative Phone Number
Parent/Guardian Email*
Primary Language Spoken at Home*
Emergency Contact*
Emergency Contact Phone Number*
Emergency Contact Relationship to Player*
Does Your Student Have Any Allergies or Medical Issues?*
Learn to Skate Sign Up Information

Below you will select which 6 week Learn to Skate Session you would like to sign up for. Currently we are offering the following dates and locations for new sign ups:

Simons Recreation Center (7200 Woolston Ave. Philadelphia, PA 19138)

(Monday/Wednesday)

Session 1 - April 22nd

Laura Sims Skate House (200 S. 63rd Street Philadelphia, PA 19139)

(Tuesday/Thursday)

Session 1 - April 18th

Scanlon Recreation Center (1099 E. Venango Street Philadelphia, PA 19134)

(Tuesday/Thursday)

Session 1 - April 11th

Tarken Recreation Center (6250 Frontenac Street Philadelphia, PA 19111)

(Tuesday/Thursday)

Session 1 - April 9th

Class of 1923 Arena at UPenn (3130 Walnut Street Philadelphia, PA 19104)

(Tuesday/Thursday)

Session 1 - CLOSED

In order to sign up for a session please select the location first, and then the first date based on the information provided above. For example if you would like to sign up for option number one please select "Simons" in the "Location" drop down and then "Simons-4/22/2024" in the "LTS Session Start Date" dropdown. Prior to the sessions start date a representative from Snider Hockey will reach out to you confirming your participation and more information on getting equipment for your child.
Which rink location do you live closest to?*
Learn to Skate Session Start Date*

How did you hear about Ed Snider Youth Hockey & Education?*

Waiver
2023-24 Snider Participant Waiver
By checking here, you are confirming that you have read, understand and agree to the terms of this waiver.*
Additional Information
Shirt Size
Shoe Size
PLEASE COMPLETE AND SUBMIT THIS FORM ONLY ONCE
Student Information
Student First Name
Student Last Name
Student Sex
Student Date of Birth
Student Race/Ethnicity
Do you live in Philadelphia?
Street Address
City
State
Zip Code
Student's Current School
Student's Current Grade
Parent/Guardian Information
Parent/Guardian Name
Parent/Guardian Phone Number
Parent/Guardian Alternative Phone Number
Parent/Guardian Email
Primary Language Spoken at Home
Emergency Contact
Emergency Contact Phone Number
Emergency Contact Relationship to Player
Does Your Student Have Any Allergies or Medical Issues?
Learn to Skate Sign Up Information

Below you will select which 6 week Learn to Skate Session you would like to sign up for. Currently we are offering the following dates and locations for new sign ups:

Simons Recreation Center (7200 Woolston Ave. Philadelphia, PA 19138)

(Monday/Wednesday)

Session 1 - April 22nd

Laura Sims Skate House (200 S. 63rd Street Philadelphia, PA 19139)

(Tuesday/Thursday)

Session 1 - April 18th

Scanlon Recreation Center (1099 E. Venango Street Philadelphia, PA 19134)

(Tuesday/Thursday)

Session 1 - April 11th

Tarken Recreation Center (6250 Frontenac Street Philadelphia, PA 19111)

(Tuesday/Thursday)

Session 1 - April 9th

Class of 1923 Arena at UPenn (3130 Walnut Street Philadelphia, PA 19104)

(Tuesday/Thursday)

Session 1 - CLOSED

In order to sign up for a session please select the location first, and then the first date based on the information provided above. For example if you would like to sign up for option number one please select "Simons" in the "Location" drop down and then "Simons-4/22/2024" in the "LTS Session Start Date" dropdown. Prior to the sessions start date a representative from Snider Hockey will reach out to you confirming your participation and more information on getting equipment for your child.
Which rink location do you live closest to?
Learn to Skate Session Start Date

How did you hear about Ed Snider Youth Hockey & Education?

Waiver
2023-24 Snider Participant Waiver
By checking here, you are confirming that you have read, understand and agree to the terms of this waiver.
Additional Information
Shirt Size
Shoe Size

Fields marked with an asterisk (*) are required.

Ed Snider Youth Hockey & Education

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