Spring & Summer Sessions

Mite & Squirt Clinics
Release Waiver and Application
(Payment is due with 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 _____________________________ State: ___________________   Zip ________________

Home Phone ___________________________ Birth Date ___________________

Email _________________________________________________________

Experience _________________________________________________________

 

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


Please Select Which Group:   (circle choice)
 

  • April 8 - June 3   5:20pm
    Mondays - Squirt Classes
    No classes Memorial Day May 28
     

  • April 9 - May 28   4:30pm
    Tuesdays - Mite Classes
     

  • April 9 - May 28   5:40pm
    Tuesdays - Mite Classes

  • June 10 - July 29   5:20pm
    Mondays - Squirt Classes
     

  • June 4 - July 23   4:30pm
    Tuesdays - Mite Classes
     

  • June 4 - July 23   5:40pm
    Tuesdays - Mite Clinic


All Sessions are SIXTY Minutes Long

ALL STUDENTS ARE REQUIRED TO HELMETS WITH FACE MASKS

I HEAR BY ABSOLVE HOCKEYTOWN U.S.A., INC. , THE CHAMPIONSHIP HOCKEY SCHOOL AND THEIR INSTRUCTORS FROM ALL LIABILITY FOR INJURIES TO THESE REGISTERED PERSONS DURING THESE SCHOOL SESSIONS.  I HEREBY ATTEST THAT THE APPLICANT IS IN GOOD HEALTH AND ABLE TO PARTICIPATE IN THE PHYSICAL ACTIVITY OF A VIGOROUS ATHLETIC PROGRAM.  IN THE EVENT OF INJURY OR ILLNESS, THE SCHOOL HAS MY PERMISSION TO PROVIDE EMERGENCY FIRST AID CARE



THE COACHING STAFF RESERVES THE  OPTION TO CHANGE THE CURRICULUM WHEN IN THEIR OPINION IT BECOMES NECESSARY FOR IMPROVEMENT TO THE STUDENTS OVERALL ABILITY AS HOCKEY PLAYERS.    

 

Please print and mail to:

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

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