IceWorks Hockey Clinic Registration Form

BOYS and GIRLS AGES 4 through 9 years old

To Register Online:
Please complete and submit the following form to register for this program.

Clinic Selection Information
Try Hockey For FREE Saturday, November 12, 2016 12:30pm - 1:30pm   Price: FREE
Player's Information
Player's Name: Age:
City: State: Zip:
Day Phone: Evening Phone:
Emergency Contact
Contact's Name:
Emergency Phone:
Medical Emergency
Hold Harmless Agreement
The above applicant agrees to follow the rules and regulations of IceWorks and releases an holds harmless Iceworks, from any and all injury and all liability, loss or damage.

Assumption of Risk Agreement and Release
Upon entering events sponsored by IceWorks and/or its Agents or Affiliates, I/We abide by the rules of IceWorks as currently published. I/We understand and appreciate that participation or observation of sports constitutes a risk to me/us of serious injury, including permanent paralysis or death. I/We voluntarily knowingly recognize, accept, and assume this risk and release IceWorks, it affiliates, their sponsors, events organizers and officials from any liability thereof.

Medical Release
The above applicant does hereby authorize IceWorks and its employees and agents to make any and all decisions in my absence regarding medical emergency treatment of the above applicant and to sign the necessary hospital release forms in order to obtain medical attention. In case of emergency I can be reached at the number provided in the above form.

Please select the following button to indicate your agreement with regard to the above Medical Emergency and Assumption of Risk statements. Upon submission of this form, user/applicant agrees that he/she is over 18 years of age or is the legal guardian of the person indicated in the "Name" fields of this form.

Please submit any additional comments that may help us in processing your application.

Applications must be accompanied by full payment. No refunds of credits once class begins. There will be no makeup classes unless class is cancelled by the rink. All applications must be received 3 days prior to the start of the first class.