LEARN TO SKATE REGISTRATION

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Player Information

Name

First Name

Last Name

Address

Street Address

City

Country

Home Phone Number

Date of Birth

School Name

Parent/Guardian Information

Name

First Name

Last Name

Cell Phone Number

Email Address

Additional Parent/Guardian Information

Name

First Name

Last Name

Phone

Bellmore Merrick Roller Hockey Registration Waiver

I, the Parent or Guardian of the registered named child, hereby give my approval of his/her participation in any of the activities of the Bellmore Merrick Roller Hockey League during the current session. I assume all risks and hazards incidental to this activity, and transportation to and from the activity. I do further indemnify and hold harmless, Bellmore Merrick Roller Hockey, the organizers, supervisors, coaches and sponsors, from any and all claims resulting in connection with my child’s participation, including but not limited to, personal injury, wrongful decision, death or dismemberment. I further certify that I am the parent or legal guardian of the named applicant(s) and all of the information I have provided is true to the best of my knowledge.

I understand that the registration fee includes all insurance costs and all registrations are final, no refunds will be provided.

Please sign to agree to our terms and conditions

Full Name

Sign

Registration Fee

Price$150.00

Payment

Discount

Subtotal

Tax

Total USD

Week	Date	Time
1	3/9	10am - 10:30am
2	3/16	10am - 10:30am
3	3/23	10am - 10:30am
4	4/6	10am - 10:30am
5	4/13	10am - 10:30am
6	4/20	10am - 10:30am

LEARN TO SKATE AT BMRH

LEARN TO SKATE AT BMRH