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Enroll Now - Space is Limited!
'08 Registration Form
Online Registration Instructions:
(1) Fill out the following form,
(2) Read both the Medical Release and the Release of
Liability/Acknowledgement of Risk
(3) Submit the form. Your spot will be held for 7 days
while we await your signed check.
(4) On the confirmation page, verify that all information is
correct, and then print the page.
(5) Sign the printed copy, acknowledging that you have read
and understood the both the Medical Release and the Release of
Liability/Acknowledgement of Risk
(6) Attach your check and mail to:
Garry
Hebert Enterprises, Inc.
PO Box 347, Accord, MA 02018-0347
Phone: (781) 871-5595
Fax: (781) 871-8372
(7) A confirmation will be sent on receipt of your check
and your signed copy of the application based on class availability.
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First Name
Required entry - letters only
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Last Name
Required entry
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Street
Required entry
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City
Required
entry
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State
Required entry - two letters
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Zip
Required
entry - five numbers minimum
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Home Phone
Required entry - 10
numbers
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Work Phone
Required entry
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FAX
Optional
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Email
Required
entry
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Birth_Date
Required
entry - (MM/DD/YY)
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Height
Required
entry - (5'6")
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Weight
lbs. Required
entry - Numbers only
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# Years Playing
Required
entry - Numbers only
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Present School Grade
Required
entry
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School Name
Required
entry
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Mother's Name
Required
entry
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Father's Name
Required
entry
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Emergency Phone Numbers
Required entry
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Medical Insurance Carrier
Required entry
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Please Remember
the Following:
- Unless otherwise
noted above, the Cost for all schools is $225.00
if FULL payment is received BY
May 31, 2008.
- If the Balance
is received AFTER May 31, 2008 the cost is $245.00.
- A $100 deposit
must accompany your application for each session per child.
- DISCOUNTS –
Individual: deduct $10 per school if multiple schools are chosen
by an individual player. Family: if more than one child is
attending per family, deduct $10 per child from original cost. See
above #1 and #2.
- All deposits are
non-refundable.
- Final
payment is due 4 weeks prior to start of
session, unless full payment was sent prior to May 31, ensuring your
discount.
- Medical and
Liability Releases must be signed.
- We look forward to
sending you a confirmation letter upon receipt of your
application based on class availability.
- Please return application and check payable to:
Garry Hebert Enterprises, Inc.
PO Box 347, Accord, MA 02018-0347
Phone: (781) 871-5595
Fax: (781) 871-8372
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Please Read and
Check Boxes Before Submitting:
Medical Release I acknowledge the applicant 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 absence of
parent or legal guardian, I give my permission for the person in charge
to seek medical attention.
I
have read the Medical Release
Release of Liability/Acknowledgement of Risk
Upon entering the Garry Hebert Hockey Event, I/We understand that
participation in the sport of ice hockey, as well as in this event,
constitutes a risk to me/us or serious injury, including permanent
paralysis or death. I/We voluntarily and knowingly recognize, accept and
assume the risk and release Garry Hebert, his sponsors, event organizers,
staff members, the skating facility and officials from any liability
therefore.
I have
read the Release of Liability/Acknowledgement of Risk
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Parent or Guardian Signature / Date
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Garry
Hebert Enterprises, Inc.
PO Box 347, Accord, MA 02018-0347
Phone: (781)-871-5595
FAX: (781) 871-8372
Last
Updated: February 20, 2008,
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