Student _________________________ Nickname ________
Street Address ___________________________________
City ______________________ State _____ Zip ________
Street Address ___________________________________
City ______________________ State _____ Zip ________
Home Tel# _______________ Emergency Tel# _______________
Enclosed please find a non-refundable deposit (in the amount noted below) to reserve a spot in the checked program. I understand this deposit is to reserve one of the limited slots, and that incremental payments are due as shown:
Enclosed please find a non-refundable deposit (in the amount noted below) to reserve a spot in the checked program. I understand this deposit is to reserve one of the limited slots, and that incremental payments are due as shown:
(Spaces available on a first come, first served basis)
I hereby acknowledge and fully understand that participation in the events and/or activities contemplated herein involve risks of serious injury, including permanent disability, death, dismemberment and any and all hazards incidental to the conduct of the events and/or activities, affiliated clubs, respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, arena owner sand/or lessees, New England Hockey, Inc. ("NEHI"), its successors and assigns,sponsors, supervisors, coaches and directors ("Released Parties"), and each and every one of them, and I hereby assume all risks as aforementioned. I hereby authorize the Released Parties to provide any and all emergency medical care for the participant. I further release, indemnify, and hold the Released Parties harmless from and against any and all injuries incurred before, at, or after, any and all events and/or activities, and also absolve and release each and every one of them from any claims against any person(s) involved in transportation to and from any and all such events and/or activities. I waive any and all rights and claims relative to proprietary rights NEHI holds relative to video reproductions,photographs and any other imagery relative to any and all NEHI events and/or activities. I also understand that there are no refunds on deposits.
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Signature (Parent or Guardian).....................................Date
