Inside the Box Summer 2013 | Page 5

A chance for players to develop their hockey skills in a game environment focusing on FUN
* LIMITED SPOTS AVAILABLE * Spots filled on a first come basis *
To ensure your spot in the skate , please return this application on or before June 28th along with payment of $ 60.00 payable to the Ice Box Sports Center .
Dates and Game Times
6:00 pm Mites 7:00 pm Squirts 8:00 pm Pee Wee 9:00 pm Bantam
Tuesday , July 9 Tuesday , July 16 Tuesday , July 23 Tuesday , July 30 Tuesday , August 6 Tuesday , August 13
COST $ 60.00 per player or Drop in for $ 12 per skate
Registration Deadline June 28th , 2013
Name _________________________________________________
Address _______________________________________________
City ________________________ State _______ Zip ___________
Phone _________________________________________________
Email ________________________________________________
DOB ______________________
Jersey Size : Sm Med Lg XL Youth Adult
What division did you play in the fall ?______________________
Parent ' s Name _________________________________________
I understand and accept that the risk of injury is possible while playing the sport of hockey . I hereby release , indemnify , and hold harmless the Ice Box Sports Center , their officers , officials , agents and / or employees , other participants , sponsoring agencies , sponsors , advertisers , and if applicable , owners and lessors of premises used to conduct the event . With respect to any and all injury , disability , death , and or damage to person or property , whether arising from the negligence of the releasees or otherwise , to the fullest extent of the law .
_______________________________________ ______________ Parent ' s Signature
Date
ALL SKATES HELD AT THE ICE BOX SPORTS CENTER 21902 Telegraph Rd ., Brownstown , MI 48183 PH . 734-676-5500 Email : mcannon @ iceboxsports . com www . iceboxsports . com