2011 School Signup Form

Name:
Address:
City:
State:
Zip:
Work Phone (123-456-7890):
Home Phone (123-456-7890):
Birthdate of Student (mm/dd/yyyy):
Team:
Level:
Email:
Jersey size:
Youth-S Youth-M Youth-L
Mens-S Mens-M Mens- L Mens- XL Mens-XXL 
Mens-XXXL
School Choice:
Emergency Information
Contact Name:
Relationship to Student:
Phone:
Waiver Agreement
The undersigned hereby recognizes and acknowledges that ice hockey is a contact sport in which there are injuries to participants. In recognition of this and desiring to participate in the Good As Gould Goalie School (The School); and in consideration of my enrollment, I agree to indemnify, release, discharge, and hold harmless Gould Goalie Equipment, Inc. – sponsor of the Good As Gould Goalie School – and it’s officers, directors, agents, servants, employees, sponsors and any ice or recreational facility used in connection with "The School" from any and all liabilities, losses, costs, claims and damages or expenses of whatever nature which I or my successors or assigns may have for any injury or otherwise sustained by me which arises directly or indirectly out of or in connection with my enrollment or participation in the programs sponsored by Gould Goalie Equipment, Inc., I understand that this waiver and release shall be binding upon my heirs, legal representatives, and assigns and shall inure to the benefit of Gould Goalie Equipment, Inc., it’s officers, directors, agents, servants, employees, and sponsors and their respective successors and assigns. Gould Goalie Equipment Inc. reserves the right to use and pictures or video taken during The School for advertising, promotional and/or instructional purposes.
To sign this application and accept the waiver agreement please PRINT your name and enter a date. By doing so, you agree to the Waiver Agreement.

Name:
Waiver Date: