REGISTER FOR PASI STICKHANDLING (download and fax application)


  Your Name: (required)                                          Phone Number:                                E-mail Address: (required)


  Address:                                                                   City:                                                     Zip Code:


  Child's Age:                      Birthdate:                      Years played:                                     Current Team:


  Insurance Carrier:                                                  Insurance Policy Number:             Emergency Contact:


  Emergency Contact Number:                                 Number of Sessions Interested in?


 Notes and Comments:       


Release & Indemnity: I will not hold P.A.S.I. Instructors, employees, or affiliates responsible or liable for accident, injury, or loss caused during attendance at the skills camp.        ACCEPT        DECLINE