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Learn To Skate Registration Form

09/28/2018, 3:30pm EDT
By Admin

Download Form

 

2018-19 LEARN TO SKATE PROGRAM

Please Read Carefully and Complete

 

Session I (12 Weeks): Saturday & Sunday Mornings 8am to 9 am; 10/6 thru 12/30

Session II (12 Weeks): January 2019 thru March 2019 (exact dates TBD)

Cost: $195 Per Session -- ______ Session I ______ Session II

 

Player Information:

Player Name D.O.B. / /

Address City

State Zip Code Home Phone:

Father’s Name

Mother’s Name

 

Primary Parent(s)/Guardian:

Mom’s Cell Phone ( ) -

Dad’s Cell Phone ( ) -

 

Primary Email:

Secondary Email:

 

Release and Acknowledgment:

I am aware that hockey is a contact sport. I agree that the New Hampshire Avalanche hockey organization, the Ice Den Arena, and their agents, sponsors, owners and employees shall not be liable to me for any injury resulting directly or indirectly from any participation with the New Hampshire Avalanche hockey organization, whether from skating or ice hockey, whether incurred on the ice, in o r about buildings and grounds. I further agree that I discharge the New Hampshire Avalanche hockey organization, the Ice Den Arena, and their agents, sponsors, owners and employees from all claims and demands that I may have for any injury or damage. I agree t hat my “Release and Acknowledgment” discharge shall bind my heirs, legal representatives and assigns, and shall inure to the benefit of the New Hampshire Avalanche hockey organization, the Ice Den Arena, and their agents, sponsors, owners and employees and their successors and assigns. I certify that the above named child is physically and medically qualified to participate in any and all activities of the New Hampshire Avalanche hockey organization.

 

Medical Release:

As parent or guardian of the above named child, I authorize the New Hampshire Avalanche Hockey Organization coaches or manager to authorize medical assistance for him/her in the event that I am not present. This authorization will remain in force through the 2018-2019 hockey season.

 

Medical Conditions:

My child is allergic to the following medication(s):______________________________________________________________

 

The above named child is under a physician’s care for and/or has the following special condition:

 

 

Signature (Parent/Guardian): Date:______________

 

New Hampshire Avalanche · 600 Quality Drive · Hooksett, NH 03106

TEL: 603-668-0795 / FAX: 603-668-1798 / www.nhavalanche.com

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