AUGUST 2021 LEARN TO PLAY OPEN TO BOYS & GIRLS AGES 5-14!

We thank you for choosing Mid-Hudson Civic Center Inc. Learn to Play. Our ICETIME SPORTS COMPLEX youth hockey program offers children a chance to learn and play the great NEWBURGH, NY game of hockey at an affordable price in a fun, safe, and positive atmosphere. With an emphasis on skill development, teamwork, respect, sportsmanship, team camaraderie, and building lifelong friendships, the youth hockey 5-WEEKS program offers young players a great opportunity to grow, Not only as players, but as individuals as well. Learn to Play will teach your child the basic skills of TUESDAYS stick-handling, passing, and shooting through 5 one-hour lessons. In addition, AUGUST 3, 2021 - AUGUST 31, 2021 they will learn about hard-work and commitment. This program is designed for children ages 5 - 14 years old with little or no hockey experience. Each 6:00PM-7:00PM session is limited and space will be filled at a first-come, first-served basis. Pre-registration is required. No equipment is provided. 5 WEEK FEE - $125 Please note: IceTime Sports Complex follows a strict USA Hockey Zero-Tolerance Policy. WALK-IN FEE - $30

MORE EMAIL: [email protected] CALL: (845) 567-0005 INFO RESERVE ONLINE: Midhudsonciviccenter.ezfacility.com

MIDHUDSONCIVICCENTER.ORG AUGUST 2021 LEARN TO PLAY

2021 REGISTRATION FORM - PARTICIPANT INFO

NAME:______AGE:______DOB:______

GENDER:______ADDRESS:______

CITY:______STATE:______ZIP: ______

PHONE #: ______EMAIL: ______

PARENTS NAME: ______

HOW DID YOU HEAR ABOUT US: ______AUGUST 2021 TUESDAYS AUGUST 3 - AUGUST 31 LEARN TO PLAY: 6:00PM - 7:00PM $125 - 5 Weeks $30 Walk-in Fee

PAYMENT POLICIES REQUIRED EQUIPMENT ATTENDANCE POLICY Payment in full due upon registration, Learn to Play: with For safety reasons, parents are required to drop off and pick no exceptions. Returned checks will be full face mask • ice hockey gloves and up skaters inside the building. The MHCC Inc. do not assume charged a fee of $40. There will be no pants • ice hockey skates and stick • responsibility for children participating in classes at any time. refunds, no exceptions. Family Discount: mouth and neck guard • elbow, shin, Anyone under the age of 18 must be accompanied by an adult Second family member qualifies for and • athletic cup • ice into the building. Makeups or Credits: There will be no makeups 10% off the lowest priced program. . or substitutions. Class Schedules: Schedules are tentative and Not valid on Open Freestyle. SKATE RENTALS ARE $5.00 subject to change due to enrollment or special events.

CARDHOLDER NAME:______EXP. DATE:______

ACCT #: ______3 DIGIT SECURITY CODE: ______

Payment Info: Please make checks payable to Mid-Hudson Civic Center Inc. Mastercard or Visa only for credit card payments (+admin fee of 4%). Checks can be mailed to: Mid-Hudson Civic Center Inc. Box Office, 14 Civic Center Plaza, Poughkeepsie, NY 12601

WAIVER The undersigned parent(s) or guardian(s) of the above-named minor or participant in the athletics/sports program and related events and activities at Mid-Hudson Civic Center, Inc.: 1. Acknowledge(s) that the participant will be engaging in activities that involve risk of injury and property damage and the undersigned agree(s) to assume all risk and responsibility in connection therewith. 2. Agree(s) to inspect the facilities and equipment and will advise the coach or supervisor of any unsafe condition and will instruct the participant to do the same and the participant will not participate until safety is restored. 3. Agree(s) to be responsible for providing the participant with protective equipment, including helmet. 4. Release(s) and discharge(s) the Mid-Hudson Civic Center, Inc., Civic Properties, Inc. and their officers, directors, employees, and agents from any and all claims, demands, actions and causes of action arising out of the activities to be engaged in by the minor, including without limitation, injuries to life, limb, or property. 5. Grants permis- sion for the Mid-Hudson Civic Center to publish photos or videos of self and children to the website, on-line and off-line publications. I give Mid-Hudson Civic Center, Inc. the perpetual, royalty-free right to use photos or videos. No confidential member information shall be published. All photographs and video footage shall remain the sole property of MHCC, Inc. I understand that no compensation will me made for this use. In the case of a press release regarding a test passes or annual ice exhibition I do give permission to use my child’s full name. EQUIPMENT INFORMATION The following equipment MUST be worn at all times for Mid-Hudson Civic Center, Inc. Learn to Play Hockey: Ice with face mask, mouth guard, neck guard, elbow pads, gloves, athletic cup, shin pads, & shoulder pads. Players without the proper equipment will not be allowed to par- ticipate in o n-ice events. I/WE HAVE READ THE ABOVE DISCLOSURE, WAIVER AND RELEASE AND UNDERSTAND IT AND SIGN IT VOLUNTARILY

SIGNATURE: ______DATE:______

PRINT NAME: ______