Skill Development Clinic ~ Fall/Winter 2011-12
Registration Form

September 29, 2011


Player Information

Name:           

Address:    City:   Zip:    

Home Phone#:             Birth Date:


Skill Development Niles Iceland Rink   Session #1       Session #2     Session #3       Session #4  


Ice Company Hockey/Skating Inc. Injury Waiver Form
The undersigned herby recognizes and acknowledges that ice hockey is a contact sport, in which there are risks or injury to participants. In recognition of this and desiring to participate in the programs sponsored by Ice Company Hockey/Skating Inc., (Ice Company), and in consideration for my enrollment, I for myself and my child agree to indemnify, release, discharge, and hold harmless Ice Company and it's officers, directors, agents, servants, employees, sponsors and any ice or recreational facility used in connection with Ice Company's programs from any and all liabilities, losses, cost, claims, and damages or expenses of whatever nature which I, my children, our successors and assigns may have for any injury or otherwise, sustained by me or my child which arises directly or indirectly out of or in connection with either me or my child's enrollment or participation in the programs sponsored by Ice Company. I understand that this waiver and releases shall be binding upon me, my children, or heirs, legal representatives and assigns, and shall insure to the benefit of Ice Company, its officers, directors, agents, servants, employees, and sponsors and their respective successors and assigns. 

Parent or Guardian's Signature ________________________________________________________

Date ____________________________________________________________________________

Emergency Contact ________________________________________________________________

Contact Phone Number _____________________________________________________________


Make your check made payable to: Ice Company Hockey/Skating Inc.
Sorry NO Credit Cards...

Complete form and print, mail to:
 Ice Company Hockey/Skating Inc.
794 Old Westbury Road
Crystal Lake, IL  60012



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