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