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Contact Information
Select Registration
Full Name Age Class Class Level Operations

Family: Receive $5.00 off each additional skater in the same family taking lessons.

Early Bird: Register and pay by August 31 to receive an additional $5.00 off .

Rewards Referral: Refer a new skater to LTS and receive $5.00 off your registration.

Full Name Birthday Operations
Name Team Name Highest level of hockey played Operations
Name Birthday Sex Operations

 
Parent/Guardian Name Address Phone # Operations

 
Emergency Contacts
Please list emergency contacts between 3:00 pm and 6:00 pm.
Health History
Please check if your child has had or does have any of the following:
General Health
Diseases
Allergies
Please describe and give dates
Days attending
Check all that apply
Camper's Name Birthday Sex Operations

 
Parent/Guardian Name Address Phone # Operations

 
Emergency Contact
Parent Authorization Form

Parental permission or power of the guardian is required in hospitals for the following: X-rays and treatment following diagnosis, treatment of all injuries requiring sutures, dressings, medications and surgery. If the parents cannot be contacted, we will call the emergency contact(s).

Allergies

Please provide any known allergies we should be aware of.

Please list any medication your child is taking.
Select Weeks
No camp 7/4/20
Each week is $200 per camper.

*Sibling discount of $50.00 a week when registering more than one child per family per week

**Sibling discount is not applied to day rates*
Full Name Age Date Operations
Emergency Contact
Waiver

In consideration of being allowed to participate in any way in Alice Noble Ice Arena (ANIA) Programs, related events and activities, the undersigned acknowledges, understands and agrees that:

1. The risks of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules equipment and personal discipline may reduce the risk, the risk of injury does exist.

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS INHERENT TO THIS AND ALL RELATED ACTIVITIES AND I ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION.

3. I willingly agree to comply with the stated and customary terms and conditions for participation.

4. I, for myself and on behalf of heirs, assigns personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS THE ALICE NOBLE ICE ARENA (ANIA), their officers, instructors, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and leasers of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property.

5. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.

6. For Participants of Minority Age (under age 18 upon registering This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and for myself, my heirs, assigns and next of kin, I do also release and agree to indemnify the Releases from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

PHOTO RELEASE

I give permission for myphotograph to be taken while participating at the ANIA, and their activities to be used for the purpose of publicity. These photos may be used for programs brochures, media productions, advertisements or news articles by ANIA.

Sign above