Indiana Blizzard

Blue Pride
http://www.indianablizzardshop.com
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2010 Full Season Fee

Full season payments are due March 31.

$170.00

2010 Full Season Fee (Family Rate)

Full season rates are due by March 31.

$300.00

2010 Half Season Fee

Half season fee payable in two installments. First installment is due March 31 and the second installment is due April 15.

$85.00

2010 Half Season Fee (Family Rate)

Half season fee payable in two installments. First installment of $150 due on March 31. Final installment due on April 15.

$150.00

Registration Information
Name:
Address:
City, State, and Zip:
Phone:
Email:
Parent / Guardian:
Birthday (mm/dd/yy):
Grade / Age:
Number:

Comments:
***Please note you will need to submit the registration by clicking the submit button above and then pay the fees below.
I do hereby acknowledge, recognize and accept the inherent risk of bodily injury, disability, paralysis and/or death to myself/ourselves and/or my/our
children that exists as a result of my/our participation in any athletic endeavor, and specifically, by my/our participation in athletic endeavors offered or hosted by the Indiana Blizzard or it's partners. As such, I/we do hereby agree to save, hold harmless and indemnify the Indiana Blizzard, its owners, employees, agents, and other individuals or entities operating on behalf of the Indiana Blizzard, for any bodily injury, disability, paralysis, and/or death, that I/we and/or my/our child(ren) may sustain as a result of my/our participation in any athletic endeavor offered.

In the event that I or my/our child(ren) suffer some type of injury or illness which requires immediate medical treatment, I do hereby consent to and authorize the administration of such first aid and/or medical treatment to myself/ourselves and or my/our child(ren) by employees and/or agents of the Indiana Blizzard. I/we do further consent to and authorize employees and/or agents of the Indiana Blizzard to arrange for ambulance transportation for an appropriate medical facility for me/us and/or child(ren).
Parent or Guardian Initials for Consent
I have read and agree to all terms and conditions above