SUMMER SPORTS CAMP 2008 REGISTRATION FORM Parent First Name: Parent Last Name: Gender: M F Date of Birth: Address: City: State: Zip: Telephone (H) : - - Telephone (W) : - - Emergency Contact: Telephone: - - List names of people who will be responsible for signing in and checking out child: Name: Telephone: - - Name: Telephone: - - Health Insurance Provider: Policy # Doctors Name: Telephone: - - Please indicate any medical conditions or special needs that we should be aware of:
Important - Read
and Sign
I am aware that ice skating
and other sporting activities involve certain inherent risks, dangers
and hazards which can result in serious injury or death. I am also aware
that ice skating rinks and recreational facilities contain dangers that
can cause serious injury or death.Therefore, I indemnify, and hold harmless Rockville Ice Arena, Montgomery Ice Arena Management Co., L.L.C., Montgomery Youth Hockey Association Inc., and their respective directors, officers, agents, employees, volunteers and affiliates (collectively "Indemnitees") from any and all costs, losses, liabilities, damages, deficiencies, claims, expenses (including costs and attorney's fees) arising from bodily injury, personal injury, including death at any time resulting therefrom, sustained during the camp. I knowingly assume all risks associated with participation, even if arising from negligence of the participants or others, and assume full responsibility for my child's participation. I certify that my child is in good physical condition and can participate in the camp. Further, I authorize the Camp Director or his/her designate to requests medical treatment as necessary to insure my child's health. ____________________________
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Print Parent/Guardian Name Parent/Guardian Signature **There is a minimum non-refundable deposit of $50 per week**
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