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Enroll Now - Space is Limited!
'10 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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Check Session(s) Attending: |
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H-1 |
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VT-1 |
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VT-2 |
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FX-1 |
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FX-2 |
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H-2 |
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PS-1 |
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PS-2 |
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MV-1 |
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MV-2 |
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ELITE-A |
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ELITE-B |
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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, 2010.
- If the Balance is received AFTER May 31, 2010 the cost is $239.00.
- 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: Feb. 14, 2010 |
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