Name_________________________________
Address________________________________
________________________________
Phone________________________ DOB___________
Email__________________________________
Emergency Contact___________________________
I am aware that ice hockey involves certin risks, dangers, and hazards which can result in serious personal injury or death. I am also aware that ice hockey rinks and arenas contain dangers that can cause serious injury or death. I hereby freely agree to assume and accept all known and unknown risks of injury arising out of ice hockey and related camp activities for my participating child.
X_______________________________________________________
Parent or guardian signature Date
_____ $399 Standard Registration Fee
______ $359 BVICE Passholder Fee
_____ ($30) Early Bird Discount (must register by Apr. 1)
Method of Payment: Cash Check CC
Credit Card #____________________________________Exp______
x__________________________________________________
signature of cardholder
Office Use: Received by_____________ on__________________
