"Bridging the gap between the athlete you are and the athlete you can become"

EDINGERS EDGE ON-ICE Performance Program

2011  Registration and Application Form 8-13 yrs old. Friday Camp

Please complete application in full. Make checks payable to Edingers Edge

Name:                                                                                           

Address:

City:                                                       State:                                                     Zip:

Phone:                                             Work:                                                              Emergency:                                                      

Medical Conditions:                                                                                                                                                                           

E-Mail Address:                                                                          

DOB:                                                     Height:                                           Weight:      

Name of 10/11 Hockey Team:                                           Position

Payment Information

Cost of complete 12 session program. June 10th-August 26th  @ Tri-Town Ice Arena = $550.00

$200.00 due by May 10^th                                                  

$200.00 due by July 1st

$150.00 due by August 5th 

*Discount*- Cost of program if payment is received in  full  by May 10th   = $500.00

Spots are limited so we can keep the class size down. So first come, first serve!!  Thank you

If a player misses a session due to whatever reason, he/she is still responsible for the cost of the session and will not be reimbursed.   I have to pay the same amount for ice time no matter how many students are there. Thank you!!

Checks payable to: Edingers Edge                   

10 Dunklee Rd. Unit 32  Bow NH 03304

Liability Waiver & Release

I                                                                                                 , hereby understand and agree that Edingers Edge performance program, it’s staff and or facilities used shall in no way be held responsible or liable for any injury suffered while attending sessions of Edingers Edge.  I give my permission for Edingers Edge performance program to act for me in any emergency requiring medical attention.  I will be responsible for any medical or other charges in connection with his/her attendance at Edingers Edge performance program.  I attest that the applicant is in good health and is able to participate in the physical activity of these intensified programs.

Medical Insurance                                                                 Policy #                                        Phone

Signature (parent/Guardian)                                                 Date

Edingers Edge

10 Dunklee Rd.  Unit 32.

Bow NH 03304

cedinger10@hotmail.com