Elementary School League
   
 
 

PLAYER INFORMATION

Player’s Name

 ________________________________________________

Address

 ________________________________________________

Parents Name:

 _________________________________ _______________________________

City

 _________________________________

State

 ________________

Birth Date
____________

Grade

 ________

Position

 ____________

(home) Phone

 _________________________________

Zip Code

 ________________

(cell) Phone

 _________________________________    

Email:

______________________________________

  @ __________________

Jersey Size

____

 yL

____

 mS

____

 mM

____

 mL

____

 mXL

School:

 ____________________

School District:

 ___________________
  

I am interested in coaching:  yes    no  

Hold Harmless Agreement

Having full knowledge and understanding of the nature of this activity and the hazards involved, I hereby certify that I have personal Medical Insurance coverage for any “bodily injury” that may occur and assume full responsibility for all losses and injuries sustained while involved in this activity as it relates to this facility.  I also hold harmless ICE LINE, its insurers, their agents, representative, and employees and any of its associates from any claim related therato
Parents Signature:______________________________ Date:_________
Print Name:______________________________ Relationship to Player::_________

Return the portion with the $215.00 Non Refundable Deposit to:

Ice Line

700 Lawrence Drive

West Chester, PA 19380

Phone: (610) 436-9670

Fax: (610) 436-4622

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