Fall Session #3: January 03Rd - February 22Nd, 2015 Skip Days: January 17Th, 18Th - February 14Th, 15Th

Fall Session #3: January 03rd - February 22nd, 2015 Skip Days: January 17th, 18th - February 14th, 15th Player First Name: ___________________ Player Last Name: _______________________________________________ Player Age: _______ Player DOB:____________ Email (Required): _________________________________________________________________________________________ Mother Name: ________________________________ Father Name:__________________________________________ Contact # (required): Home:_____________________________________ Cell:__________________________________ Address:________________________________________________________________________________________________ Emergency Contact Name and #: ___________________________________________________________________________ PROGRAM Please Check Desired Classes LEARN TO SKATE HOCKEY - (Ages 4 - 14yrs) (Saturday: 10:05am) (___) *Players need: hockey skates, hockey helmet w/mask, hockey pants, shin guards or knee pads, and elbow pads. ($95) PRE - HOCKEY LEVEL: (#1) - (Ages 4 - 14yrs) (Sunday: 4:10pm) (___) .*Players need full equipment and hockey stick. ($160) PRE - HOCKEY LEVEL: (#2) - (Ages 4 - 14yrs) (Sunday: 5:35pm) (___) .*Players need full equipment and hockey stick. ($160) “SCOOTER” POND HOCKEY- (Ages 4 - 14yrs) (Sunday 5:05pm) (____) .*Players need full equipment and hockey stick. ($65) Total Cost of Program Enrollment: $____________ Payment Type: __Credit Card / Cash / Check #__________ Payment Date:______________ Seven Bridges Ice Arena & Rocky Hockey Inc. Registration and Waiver Form Registration Policy Payment is due in full, with a completed Registration Form, prior to the start of the program. Payments must be made by Visa, Master- Card, Discover, Cash or Check: to Seven Bridges Ice Arena. NO Refunds. If a participant is unable to take part in a program due to medical reasons, he or she will receive credit towards their next Rocky Hockey program. Seven Bridges Ice Arena & Rocky Hockey Inc. reserve the WAIVER AND ASSUMPTION OF RISK AGREEMENT PARTICIPATION AGREEMENT, RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISK BY SIGNING THIS DOCUMENT YOU ARE ENTERING INTO A CONTRACT WHEREIN YOU MAY BE WAIVING CERTAIN LEGAL RIGHTS, INCLUD- ING THE RIGHT TO SUE. TO: Rocky Hockey Inc., Inc., d/b/a Rocky Hockey, SB Arena, LLC, d/b/a Seven Bridges Ice Arena (the “Arena”), Advanced Power Hockey, LLC, Advanced Arenas Inc., KL2 Holdings, Inc., and their owners, officers, directors, agents, employees, and/or representatives of the above listed organizations: ASSUMPTION OF RISK: I am aware that ice hockey is a contact sport that involves certain inherent risks, dangers and hazards which can result in seri- ous personal injury or even death. I am also aware that participants in a hockey program, camp, clinic or practice session (“program”) may be injured, whether by sticks, pucks, or by physical contact with side boards, with other participants, or with the ice. Knowing this, and desiring that the above-named minor may participate as a player in the above indicated Rocky Hockey Program, and in consideration of his or her enrollment and participation in that program, I agree to indemnify and save and hold Rocky Hockey Inc., Inc., and the other above-named entities, and their directors, instructors, agents and coaches, harmless from any and all liability for such claims for damages because of injury or otherwise sustained by the above-named minor, arising di- rectly or indirectly out of or in connection with his or her enrollment and/or participation as a player in this program. And for said minor I hereby freely agree to assume and accept any and all known and unknown risks of injury attendant to participation in this program. I further recognize and acknowledge that the risks inherent in the sport of ice hockey can be greatly reduced by wearing proper protective equipment and by using common sense and have provided these for said minor. RELEASE AND WAIVER OF CLAIMS AGREEMENT: In consideration of allowing the above-named minor to participate in this hockey program, I hereby agree to the fullest extent permitted by law, as follows: TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against Rocky Hockey Inc., the Arena, and/or any of the parties named above, arising out of or related to said minor’s participation in this hockey program; and TO RELEASE Rocky Hockey Inc., the Arena and any party named above from any and all liability for any loss, damage, injury or expense that I or said minor may suffer, or that any next of kin may suffer, arising from and as a result of said minor’s participation in this hockey program, and if applicable the use of any equipment loaned or rented, due to any cause whatsoever, including negligence of breach of contract regarding the design, manufac- ture, selection, installation, maintenance or adjustment of the equipment and in the operation, supervision, design, or maintenance of the Arena. ARBITRATION: In consideration of allowing said minor to participate in this hockey program, and also if applicable in consideration of the loan or rental of any equipment, I hereby agree to submit to binding arbitration any and all claims which I believe I may have against the Arena, and/or the above named parties arising out of or related to said minor’s participation in this hockey program. The arbitration shall be pursuant to the rules of the American Arbitration Association. The arbitrators shall apply the Federal Rules of Evidence to all proceedings. Arbitration shall be commenced within one (1) year from the date AUTHORIZED PARENT/GUARDIAN: Please Print Name Signature Date SBIA Staff Signature Date .

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