2010 WOMENS ICE HOCKEY WINTER II CLINIC APPLICATION

SATURDAY MORNINGS

10:20AM TO 11:20AM

JANUARY 16, 2010 TO APRIL 3, 2010 (12 WEEKS)

NAME _____________________________________DATE OF BIRTH____/___/___

STREET _____________________ ______________CITY_______________________

STATE_______________ZIP_______________E-MAIL________________________

HOME PHONE_____________________________ WORK PHONE______________

MOBILE PHONE________________________

     THE ABOVE NAMED REGISTRANT HAS AGREED TO PAY $190.00  TO PARTICIPATE IN THE HOCKEYTOWN USA, INC.  WOMEN’S NO CHECK ICE HOCKEY WINTER II CLINIC.  THE CLINIC WILL BE HELD ON SATURDAY MORNINGS 10:20AM TO 11:20AM.  THE TWELVE WEEK SKILL SESSION WILL BE GEARED TOWARD IMPROVING EACH PLAYERS BASIC INDIVIDUAL SKILLS SUCH AS SKATING,  PASSING & PUCK CONTROL AS WELL AS AN INTRODUCTION TO THE TEAM ASPECT OF HOCKEY INCLUDING BUT NOT LIMITED TO BREAKOUTS, TEAM FORECHECKING AND DEFENSIVE COVERAGE.  WALK ON’S WILL BE ACCEPTED FOR A FEE OF $20.00.  FULL EQUIPMENT IS REQUIRED BY ALL PARTICIPANTS. 

MAKE CHECKS PAYABLE TO HOCKEYTOWN USA AND SIGN THE LIABILITY WAIVER ON THE BACK OF THIS APPLICATION AND SEND TO THE RINK: 

                                                           C/O   HOCKEYTOWN USA

                                                            953 BROADWAY

                                                            SAUGUS, MASS 01906

APPLICANT’S SIGNATURE __________________________________DATE________________

                               FOR OFFICE USE ONLY

RECEIPT # ______________    DATE ______________

AMOUNT PAID_______________ INITIALS ___________________