ALCAN Hockey Power Skating Program

REGISTRATION FORM

Please print out a copy of this form, complete, and mail to: ALCAN Hockey, PO Box 80691, Fairbanks, AK, 99708
Or Drop off at Play It Again Sports or Sport King in Fairbanks.

If you have any questions please contact:
Alaskan Canadian Hockey Schools: phone (907) 455-4203

NAME: _________________________________________ AGE: ____________________

ADDRESS: _______________________________________________________________

CITY: _________________________________ STATE/PROV.: _____________________

ZIP/POSTAL CODE: _________________________

PHONE: _________________________ DAY TIME PHONE: _______________________

EMAIL: ____________________________________________________________________

LAST TEAM/AGE DIVISION: __________________________________________________

YEARS OF EXPEREINCE: _____________________________________________________

HEIGHT: ________________________ WEIGHT: __________________________________

MEDICAL INFORMATION: (Allergies or any special conditions):__________________________

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I WISH TO ATTEND & ENCLOSED IS A CHECK FOR THE FOLLOWING CAMP:

Full Program: ($500): _____            *Deposit: ($150) ______

* Deposit is non-refundable to reserve placement in program  

ALASKAN-CANADIAN HOCKEY SCHOOLS INSURANCE WAIVER

The applicant, his/her parents and/or guardians, acknowledge that ice hockey is a contact sport, and agree the ALASKAN-CANADIAN HOCKEY SCHOOLS, its agents, servants, employees, instructors, and directors, shall be held harmless and not liable for any injury or damage to the participants as a result directly or indirectly caused by attending the school. The applicant, his/her parents and/or guardians also agree to indemnify the BIG DIPPER ICE ARENA, FAIRBANKS NORTH STAR BOROUGH, UAF PATTY CENTER, and the UNIVERSITY OF ALASKA FAIRBANKS, their employees, agents, and managers from all claims and damages.

NAME OF PLAYER: ________________________________ DATE: __________________

SIGNATURE OF PARENT OR GUARDIAN: ______________________________________