Name:

Age: Male      Female         Years of Hockey Experience:

Parent/Guardian:

Address:

Phone: Home                                    Work                                    Cell

Email:

Choose One or Both:

Skills & Drills Tuesdays @ 6:30 July 8 through August 26^th $95.00

The player named above has my permission to participate in the activities of the Lamoille Area Hockey Association. I agree to pay the fees and abide by the policies established by the Board of Directors. If I fail to do so, the player will not be allowed to participate. I will not hold responsible LAHA, its officers and coaches; or the Lamoille Area Recreational Center (LARC formally CREW) Ice Rink and its staff for any incidents or injuries occurring as a result of activities sponsored or directed by LAHA. I give my permission for LAHA or its representatives to obtain emergency medical attention for my child if I am not available for consultation at the time of injury.

Parent/Guardian Name Signature Date