ADULT HOCKEY REGISTRATION AT THE CHELMSFORD FORUM
 
Session:*  

Player Information   Payment Information
First Name:*
Last Name:*
Street:*
Apt:
City:*
State:*
Zip Code:*
Phone (Evening):*  ( – 
Phone (Daytime):*  ( – 
Cell Phone:  ( – 
Email:*
Notes:
 
Amount to be Charged: $180
Credit Card Type: *
Name on Card: *
Billing Address same as Player's Address
Billing Street:*
Billing Apt:
Billing City:*
Billing State:*
Billing Zip Code:*
Card Number: *
Enter numbers only, no spaces or dashes
Expiry Date *   
Waiver
I understand that accident, health and personal insurance are not provided and that I am personally responsible for my own insurance. I verify the above information to be true. I hereby waive, release, absolve, indemnify and agree to hold blameless Valley Associates Inc., GLS Associates, Inc. and Frost Realty Associates V, LLC as well as the aforementioned entities' organizers, sponsors, supervisors, principals, partners, employees and participants for any claims arising from any personal injury to myself and/or another participant or instructor. I acknowledge that ice hockey is a dangerous sport and assume all risks and hazards incidental to such activities and participation.
I Accept


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