ITHACA HOCKEY ACADEMY

Spring Session
April 17, 2012 thru June 17, 2012
All Inclusive program for only $195.00
Initiation level for $145.00

You have been selected
Ithaca Hockey Academy
CRC The Rink (607-277-7465)     1767 East Shore Drive, Ithaca NY 14850
PLEASE CIRCLE LEVEL OF PLAY
MITE       SQUIRT       PEEWEE/BANTAM      GOALIE    INITIATION  
  
  Name: __________________________________________
   Age:_________  Date of Birth:___________________
 
     Address:_________________________________________
    e-mail:__________________________________________
    Level of play__________________ years of play_______
     
checks made payable to COMMUNITY RECREATION CENTER,   or pay by
     Credit Card #______________________________exp________
    
Liability Waiver
     The participant agrees that Community recreation Center, our instructors
     and the Skating Rink will not be held responsible for any accidents or loss,
     however caused, and agrees to release the proprietors and/or CRC from all claims
     or damages which may arise as a result of or any reason of such accident or loss.

      Please print

    Name_____________________________________ (parent/guardian of minor)

          Signature :_________________________________(parent/guardian of minor)  
Todays Date____________

Original Site design by: 
Andrew Love

Email: The Rink