Parmy's LLC
Registration Form
Summer 2007 - Off Ice Program

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, Thursdays,
June 25 - August 30
Check Camp Code Type Eligibility Times Cost
  CHSOFF1 Off Ice High School 10:00am - 12:00pm $750
  CCOFF2 Off Ice High School 12:00am - 2:00pm $750
  CHSOFF3 Off Ice High School 2:00pm - 4:00pm $750
  CHSOFF4 Off Ice High School 4:00pm - 6:00pm $750
  CJHSOFF1 Off Ice Jr. High School 6:00pm - 8:00pm $750



Location - Canton Sportsplex, Canton MA, Mondays, Tuesdays and Fridays,
June 19 - August 24
Check Camp Code Type Eligibility Times Cost
  CCOFF1 Off Ice College 4:30pm - 6:00pm $600



Location - Canton Sportsplex, Canton MA, Sundays
June 24 - August 26
Check Camp Code Type Eligibility Times Cost
  CHSGOff Off Ice High School Girls 4:15pm - 5:15pm $240
  C95Off Off Ice 95's 5:30pm - 6:30pm $240
  C96Off Off Ice 96's 6:30pm - 7:30pm $240



Location - CDL Arena, Raynham MA, Tuesdays, Thursdays and Fridays,
June 26 - August 31
Check Camp Code Type Eligibility Times Cost
  RHSOFF1 Off Ice High School 11:00am - 1:00pm $750
  RHSOFF2 Off Ice High School 1:00pm - 3:00pm $750
  RHSOFF3 Off Ice High School 3:00pm - 5:00pm $750


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