SOUTH INDY HOCKEY

FOR REGISTRATION INFORMATION:

Phone: ????????
E-Mail: Click Here!
Register On-Line: Now Available!

Registration Note: If an accepted application is withdrawn for any reason up until 10 days prior to the start of camp session, you will receive a refund less a $35 cancellation fee. .

Please complete the form below and submit camp payment.

 
Parent's/Guardian Name*
 
Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Camper's School*
 
Camper's Home Phone #*
 
Parent's Cell Phone #*
 
Parent's E-Mail Address*
 
Birthdate (Month/Day/Year)*
 
T-Shirt Size (Youth Sizes)*
 Youth-S
 Youth-M
 Youth-L
 Adult-S
 Adult-M
 Adult-L
 Adult-XL
 
If the camper should be restricted from any activity, please note
 
Allergic Reactions
 

* I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf of said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give consent to such medical treatment as deemed necessary including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.  

* Waiver: In consideration of being allowed to participate in the South Indy Summer Off Ice Hockey Clinic, I, for myself, my heirs, personal representatives or assigns, do herby release, waive, discharge and covenant not to sue ???????, Forward Marketing LLC, its officers, employees and agents for liability from any and all claims including the negligence of theSouth Indy Summer Off Ice Hockey Clinic, Forward Marketing LLC, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the South Indy Summer Off Ice Hockey Clinic.  

Parent/Guardian Name*
 
Date*
 


PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field.
We need a registration form and consents completed for each participant.

 
Qty 
 $100.00 Individual Registration - Payment in Full