Mite & Squirt Clinics
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 ____________________________________

Mite Ages 4-7 Years Old  -  Squirt Ages 8-12 Years Old

Please Select Which Group:   (circle choice)
 

All Sessions are SIXTY Minutes Long

Please print and mail to:

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