Thank you for your interest in the Anaheim Ducks S.C.O.R.E. Street Hockey Program. Please fill out the application with as much detail as possible. Based on your response, we will assess if your school is a match for our program. The ultimate goal of this application is to determine if your school property, resources, faculty, administration, and parental support will provide the best physical education experience for your students.

Name:
Email:
Phone Number:
School Name:
School Address:
School City:
School State:
School Zip:
Total Students:
School Affiliation:	Parent Teacher Administrator Other
If you are a teacher or parent, please select the grade level of your students or child:
Select One 1 2 3 4 5 6 7 8 HS Other
Describe the school’s physical education program and facilities (playground, storage, etc.):
Who makes up your school’s physical education staff/team?
Does your school currently teach hockey as an in-school PE module? If so, how would you like the Ducks to support your curriculum?