Newton Indoor Sports Center

Adult Roller Hockey Registration Form

 

 

………………………………….Application………………………………………

 

Name_______________________________________________ Age/DOB_____/_____/_________

Address_________________________________________________________________

            _________________________________________________________________

City_________________________ State_______________ Zip___________________

Home Phone # (_____)_______-_______

Work Phone # (_____)_______-_______  ext._______

Email Address _______________@_______________

Emergency Contact ____________________________________

Phone # (_____)_______-_______

 

Other Individuals

Name_______________________________________________

Phone # (_____)_______-_______

 

Name_______________________________________________

Phone # (_____)_______-_______

 

Name_______________________________________________

Phone # (_____)_______-_______

 

Hold Harmless Release Form

I, the parent/guardian of the above applicant, hereby assume all risk and hazards incidental to participation in any and all league/clinic activities during the current season. I hereby waive, release, absolve, indemnify, and agree to hold harmless the organizers, sponsors, supervisors, participants, and corporation owners of the premises for any claim arising out of injury to my child.

 

Signature_____________________________________________ Date____________________

 

***Full Payment Required for Registration. Please make checks payable to: Newton Indoor Sports Center. Please mail payment with application to 125 Wells Ave., Newton MA 02459

 

 

Newton Indoor Sports Center 125 Wells Ave., Newton MA 02459 (617) 964-0400