1640 Fernando Dr. Depere, WI 54115  920-403-2000 www.cornerstoneicecenter.org

N.E.W. Women's Hockey & DRAGONS HOCKEY

2009 – 2010 REGISTRATION

COST: $280

Practices on Sunday Nights September 20, 2009 to March 21, 2010

Practices will be held on Sunday nights at 7:30pm and 8:30pm

Two options available this season

30 and Over Group (Hosting 2010 National Championships)

or

C Level Group (Hosting 2010 National Championships)

New Skaters are always welcome.

No Drop ins, you must register for this program.

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Name: ________________________________________________________

Address:______________________________________________________

City: _________________________________State:_______ Zip:______________

Phone: _____________________Email: ___________________________

Activity: Women's Hockey Group: ______________________________

Previous Skating Experience: _________________________________

Make Checks Payable to: Cornerstone Community Center (CCC)

                        1640 Fernando Drive

                        DePere, WI 54115                   

Liability Waiver:

Please read this form carefully and be aware that in signing up and participating in the program you will be waiving and releasing all claims for injuries sustained arising out of this program, including transportation services, when provided. As a participant in the program I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of injuries, damages or losses which I may sustain as a result of participating in any and all activities associated with such programs. I do hereby release and discharge the and Cornerstone Community Center Inc. and it's officers, agents, volunteers and staff from all claims resulting in injuries or damage and losses due to my participation in the activities provided by these organizations. I further indemnify and hold harmless and defend the named organizations, officers, volunteers and staff all claims resulting from injuries, damages and losses sustained by me and arising out of connection with, or in anyway associated with the activities provided. I have read and fully understand Waiver release of all claims.

 Signature: ____________________________________Date: ____________

NO REFUNDS!                                            Initials______