Spring Clinic 2022
Please fill out this form for the your child's participation in CHD Spring Clinic on Monday nights 3/21-5/23 at the Hayden Ice Rink in Lexington. Please choose clinic session by birth year.
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Email *
Player Name (last name, first name): *
Date of Birth *
MM
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DD
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YYYY
Registration For: *
Most Recent Team Played On *
Parent/ Guardian 1 *
Guardian Contact: Phone and Email *
Address *
City, State, Zip *
Parent/ Guardian 2 (Name, Phone, Email)
Emergency Contact (Name, Phone) *
Medical Concerns (Medications, Allergies, Asthma, Injury etc..) *
Medical Release: I acknowledge the participant is in good health and is able to participate  in the physical activity of a vigorous program.  In the event my child is injured during the absence of a legal guardian, I give permission for the person in charge to seek medical attention *
Release of Liability/Acknowledge of Risk: Upon entering the CHD, I/we understand that participation in the sport of hockey, as well as this event, constitutes risk to me/us/my child or serious injury. I/we voluntarily and knowingly recognize, accept and assume this risk and release the CHD, its sponsors, staff members, the skating facility and officials from any liability therefore.  I certify that the applicant participating in this clinic is full covered by a certified health insurance plan and that CHD and staff are not responsible or liable for any injury suffered by the applicant during the participation in the camp. *
Parent/ Guardian Signature             Date *
Preferred Payment *
Completing Player Registration *
Required
A copy of your responses will be emailed to the address you provided.
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