Please Circle One of the Programs
Girls (ages 9-15) - Mites & Squirts - Peewees & Bantams
$100.00 $100.00 $100.00
Name __________________________________________________
Address ________________________________________________
________________________________________________________
Phone __________________________________________________
Email __________________________________________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
Level of play for the upcoming season:
(please circle age level)
Mite Squirt Pee Wee Bantam
09/09 Grade ___________
(please circle playing level)
A B C D E Minor Major
(please circle position)
Forward Defensemen Goalie
- - - - - - - - - - - - - - - - - - - - - - - - - - - -
RELEASE OF LIABILITY: "I enroll my child in HSHC, aware of the inherent risks involved in playing ice hockey. I attest that the applicant is in good health and capable of participating in a rigorous athletic program. I voluntarily recognize, accept and assume the
risks involved and release HSHC, the rink, event organizers, and coaches involved. In the event of injury, I give permission for those in charge to seek medical attention."
Adult Signature __________________________________
Date _______________
Please mail check, payable to: HSHC
5 Bennetts Crossing
Ayer, MA 01432
