Parmy's LLC
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Name: | _________________________________________________ |
| Address: | _________________________________________________ |
| _________________________________________________ | |
| City, State & Zip: | _________________________________________________ |
| Age/Date of Birth: | ________________________ |
| Height/Weight: | ________________________ |
| Phone: | ________________________ |
| Email Address: | ________________________ |
| Emergency Contact & Phone: | _________________________________________________ |
| Current Team: | _________________________________________________ |
| Current Coach: | _________________________________________________ |
| Position: | _________________________________________________ |
Check one of the camps below.
| Location - Canton Sportsplex,
Canton MA - Mondays, Wednesdays September 5 - November 21 |
|||||
| Check | Camp Code | Eligibility | Times | Cost | |
| CHSOFF1 | Off Ice | High School | 3:30pm - 4:30pm | $480 | |
| CHSOFF2 | Off Ice | High School | 5:30pm - 6:30pm | $480 | |
| CHSOFF3 | Off Ice | High School | 6:30pm - 7:30pm | $480 | |
| CHSOFF4 | Off Ice | High School | 7:30pm - 8:30pm | $480 | |
| Location - Canton Sportsplex,
Canton MA - Tuesdays, Thursdays September 6 - November 22 |
|||||
| Check | Camp Code | Eligibility | Times | Cost | |
| CHSOFF5 | Off Ice | High School | 3:30pm - 4:30pm | $480 | |
| CHSOFF6 | Off Ice | High School | 4:30pm - 5:30pm | $480 | |
| CHSOFF7 | Off Ice | High School | 5:30pm - 6:30pm | $480 | |
| CHSOFF8 | Off Ice | High School | 6:30pm - 7:30pm | $480 | |
| Location - Canton Sportsplex,
Canton MA- Fridays, Sundays September 7 - November 25 |
|||||
| Check | Camp Code | Eligibility | Times | Cost | |
| CJHSOFF10 | Off Ice | Junior High School | 3:30pm - 4:30pm | $480 | |
Parmy's LLC Waiver: I hereby certify that the above-named Applicant is covered by a certified health insurance plan either through his/her parent, guardian or employer. I further certify that after consultation with the Applicant’s health care provider I have determined that the Applicant is sufficiently fit and healthy to participate in a vigorous physical exercise and training program.
I acknowledge that Parmy’s, LLC and its staff will have
made no independent determination of the fitness of the Applicant
for the program, and that Parmy’s and its staff shall
be held harmless and shall not be responsible or liable for
any injury suffered by the Applicant as a result of participation
in the program. I am aware of the risks of participating in
a vigorous physical exercise and training program and hereby
waive and release all claims I or the Applicant may have relating
to injuries incurred as a result of participating in the program.
I also confirm that the Applicant is in excellent health and
is able to participate in a vigorous physical training program.
Parmy’s, LLC reserves the right to reject any Applicant
if in its sole judgment such Applicant’s participation
in the program would create an undue risk of injury to the
Applicant or others, or if for any other reason it determines
that the program is not appropriate for such Applicant.
Applicant or Parent/Guardian Signature _______________________________________ Date _________________
Print Name Signed Above _______________________________________
Deposit:
We require a 50% non-refundable deposit with the registration
form. The balance is due at the first session. Applications
are taken on a first come, first serve basis. There will not
be a refund to the player if he/she leaves a session on their
own, misses a session, or is expelled from a session.
Make Checks Payable to: Parmy's, LLC
Mail check and registration form to:
Scott Parmentier
288A Highland Street
Taunton, MA 02780