Buzzer Hockey League
Release Waiver and Application

I hereby release Hockeytown USA, it's owners and instructors from all liability for injuries to these registered persons during these sessions. I hereby attest that the applicant is in good health and able to participate in physical activity of a vigorous athletic activity.

Parent or Guardian Signature

___________________________________

Date _______________________________
 

Student Name ___________________________________________

Address ________________________________________________

City _____________________________ Zip ________________

Home Phone ___________________________ Birth Date ___________________

Email _____________________________________________________

Experience _________________________________________________________

New Student ____________________________________

  Buzzer Hockey League  Ages 4-10 Year Olds
 

Please Select Which Group:   (circle choice)
 

April 12 - May 31   6:30pm Mondays - Buzzer Hockey   April 15 - June 3   5:20pm Thursdays - Buzzer Hockey

June 7 - July 26   6:30pm Mondays - Buzzer Hockey   June 10 - July 29   5:20pm Thursdays - Buzzer Hockey

All Sessions are SIXTY Minutes Long

Please print and mail to:

Hockeytown USA,
953 Broadway, Rte 1 South
Saugus, MA 01906