Third Watch Hockey
Hockey Camp 2010
Registration Form
Directions:
1. Fill in the boxes on your         computer.
2. Print the completed form.
3. Sign the form in places designated
4. Mail the form and payment to:
Third Watch Hockey
46 Maple Leaf Lane
Hermon, Maine 04401
We will send a confirmatio by USPS to you upon receipt of your registration form.
Make Check Payable to:
Third Watch Hockey
Name:
Mailing Address:
E-Mail Address:
Date of Birth:
level (in the fall):
Position:
Contact Parent:
Home Phone:
Work Phone:
Cell Phone:
In Case the parent or guardian cannot be contacted, who can be authorized to contact?
Name:
Relationship:
Phone #:
In case of an accident or serious illness, I request that the camp director contact me. In the event that I cannot be reached, I give my permission to take any action necessary, including an ambulance to transport to the hospital.
Hospital Choice:
________________________________________________________
Signature of Parent or Guardian
________________
Date
Back to Clinic Page
Youth Hockey Organization:
I do hereby forever release Third Watch Hockey from all claims and damages which may result from participation in the Third Watch Camp. I / We also verify that the camper is covered by insurance.  It is further agreed that the Third Watch Hockey is not responsible for lost or stolen personal articles or hockey equipment.
Your signature below confirms acceptance of these terms.
Shirt Size:
X
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