Cranston Veterans Memorial Ice Rink

3 on 3 League

Spring & Summer 2008

$85 for an Individual
Jerseys are included

Player Information:

Name:___________________________________________________
D.O.B.___________________________________________________
Position: _________________________________________________

Jersey Size: S M L XL XXL

Circle Current Division: MITE   SQUIRT   PEEWEE   BANTAM

Parent/Guardian Information:

Name: __________________________________________________
Relationship: _____________________________________________
Address: _________________________________________________
________________________________________________________
Emergency Contact: ________________________________________
_________________________________________________________
Please list any medical conditions:____________________________
_________________________________________________________

Waiver

I hereby absolve Cranston Veterans Memorial Ice Rink, RMSC and its agents, officers, and employees from all liability to this registered person(s) during said sessions. I hereby attest that the applicant is in good health and is able to participate in physical activity of a vigorous athletic program. In the event of an injury and/or emergency care is needed, Cranston Veterans Memorial Ice Rink, RMSC and its agents, officers and employees have permission to provide emergency first aid care.

Print Name:_____________________ Signatue:______________________

For Management Use Only:
Payment Type:_____________________________________________
Amount:__________________________________________________
Team:____________________________________________________