WOMAN'S CLINIC
   
 

PLAYER INFORMATION

Player’s Name

 ________________________________________________

Address

 ________________________________________________

City

 _________________________________

State

 ________________

Birth Date
____________

Age

 ________

Phone

 _________________________________

Zip Code

 ________________

Cell Phone

 _________________________________    

Email:

______________________________________

  @ __________________

Amount of Sessions

____

 12

____

 6

____

 Drop In
 
  

Hold Harmless Agreement

The undersigned agrees to follow the rules and regulations of the Ice Line Skills Clinics and releases and holds harmless the employees of Ice Line and Ice Line from any physical injury and all liability, loss or damage.
Signature:______________________________ Date:_________

Return the portion with the proper payment amount to:

Ice Line

700 Lawrence Drive

West Chester, PA 19380

(610) 436-9670 x131

Attn: Rob Lewis

For more information call ICE LINE at 610-436-9670