Player _________________________ Nickname ________
Hockey Organization/s________________________
Home Address ___________________________________
City ______________________ State _____ Zip ________

__ Enclosed please find a non-refundable deposit $115 to reserve a spot on the team checked below. I understand this deposit is to reserve one of the limited slots, and that a balance payment in the amount of $200 will be paid on or before the first evening of this program.

I hereby acknowledge and fully understand that participation in the events and/or activities contemplated herein involve risks of serious injury, including permanent disability, death, dismemberment and any and all hazards incidental to the conduct of the events and/or activities, affiliated clubs, respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, arena owner sand/or lessees, New England Hockey, Inc. ("NEHI"), its successors and assigns,sponsors, supervisors, coaches and directors ("Released Parties"), and each and every one of them, and I hereby assume all risks as aforementioned. I hereby authorize the Released Parties to provide any and all emergency medical care for the participant. I further release, indemnify, and hold the Released Parties harmless from and against any and all injuries incurred before, at, or after, any and all events and/or activities, and also absolve and release each and every one of them from any claims against any person(s) involved in transportation to and from any and all such events and/or activities. I waive any and all rights and claims relative to proprietary rights NEHI holds relative to video reproductions,photographs and any other imagery relative to any and all NEHI events and/or activities. I also understand that there are no refunds on deposits.
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Signature (Parent or Guardian).....................................Date