![](3D"Registration_files/image002.jpg")
&=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; &=
nbsp; &nbs=
p; ![](3D"Registration_files/image004.gif")
Casey Kesselring
Hockey Camps
The Ice
Den Arena, 600 Quality Drive, Hooksett, NH 03106
Tel: 603-688-0795 /
FAX: 603-668-1798
Player Registration and Release Form<=
/span>
(Required for =
All
Participants for On-Ice Activities)
Please Read Carefully =
and Complete
PLEASE
MAKE YOUR NON REFUNDABLE PAYMENTS TO THE ORDER OF=
ICE DEN ARENA=
Specific Program: (H S Developm=
ent, H
S Showcase League, Pro/Am League, Sunday Skills, Specialty Camps, etc.)
Program
Desired: (please speci=
fy) ______________________=
____________________
Date_____/_____/________=
Player Name
__________________________________________
Date of Birth ___ /___ /______ &=
nbsp; Position:
_____________________________
Address____________________________=
_____
City______________________
State_____ Zip Code____________ Home
Phone (____)_____-___________<=
/p>
Email______________________________=
__ Fax
(____) _____-___________
Last Team Played For: _____________=
___
Parents/Guardians:( <=
/span>If
under 18 years of age)
First Names ____________ &
____________ Last Name____________________
Work Phone (_____) _____-_________<=
span
class=3DGramE>_ / (___=
__)
_____-__________ ext.____
Release and Acknowledg=
ment:
I am aware that hockey is a contact sport. I agr=
ee
that the Ice Den Arena, and their agents, sponsors, owners and employees sh=
all
not be liable to me for any injury resulting directly or indirectly from any
participation with the Ice Den Arena, whether from skating or ice hockey,
whether incurred on the ice or in or about buildings and grounds. I further agree that I discharge t=
he 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 that my “Release and
Acknowledgment” discharge shall bind my heirs, legal representatives =
and
assigns, and shall inure to the benefit of the Ice Den Arena, and their age=
nts,
sponsors, owners and employees and their successors and assigns. I certify that I am (or the above =
named
child is) physically and medically qualified to
participate in any and all activities of the Ice Den Arena.
Medical Release:<=
/o:p>
As parent or guardian of the above named child, I auth=
orize
the Ice Den Arena 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 2008.
My child is allergic to the following medication(s):
______________________________________________________
The above named child is un=
der a
physician’s care for and/or has the following special condition:
___________________________________________________________________________=
_____________________
Signature (Participant/Guardian): ______________________________ Date:
______________
------=_NextPart_01C866B3.D4E29F60
Content-Location: file:///C:/EA4BB24E/Registration_files/themedata.thmx
Content-Transfer-Encoding: base64
Content-Type: application/vnd.ms-officetheme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------=_NextPart_01C866B3.D4E29F60
Content-Location: file:///C:/EA4BB24E/Registration_files/colorschememapping.xml
Content-Transfer-Encoding: quoted-printable
Content-Type: text/xml