|
THE SPORT INTERNATIONAL
HOCKEY ACADEMY E-mail Address (for confirmation letter/receipt):___________________________________ Academy
Hockey Position: Forward Defense Goalie Doctor's Name:____________________________ |
|
|
|
City/State
|
Price
|
Arena,
Date
|
| O Canton, OH |
$315.00
|
Center Ice Sports Complex , June 14 - 18 |
| O Ft. Bragg, NC |
$285.00
|
Cleland Multi-Sports Complex, June 14 - 18 |
| O Hillsborough,NC |
$395.00
|
Triangle Sportsplex , June 14- 18 |
| O Fishers, IN |
$355.00
|
The Forum at Fishers, June 21 - 25 |
| O Reisterstown, MD |
$400.00
|
Reisterstown Ice Arena , June 21 - 25 |
| O Wilmington, NC |
$345.00
|
Wilmington Ice House, June 21 - 25 |
| O Nashville, TN |
$375.00
|
Centennial Sportsplex, June 28 - July 2 |
| O Rockville, MD |
$455.00
|
Rockville Ice Center, June 28 - July 2 |
| O Greensboro , NC |
$385.00
|
Ice House of Greensboro, June 28 - July 2 |
| O Raleigh, NC |
$395.00
|
The Rec. Zone, July 5 - 9 (Pro-Rating Available) |
| O Cincinnati, OH |
$350.00
|
Northland Ice Arena, July 5 - 9 |
| O Alexandria, VA |
$445.00
|
Mt. Vernon Rec. Center, July 5 - 9 |
| O Hershey, PA |
$335.00
|
Hersheypark Arena, July 12 - 16 |
| O Richmond, VA |
$450.00
|
Richmond Ice Zone, July 12 - 16 |
| O Dayton, OH |
$335.00
|
South Metro Sports, July 12 - 16 |
| O Hampton Roads,VA |
$345.00
|
Hampton Roads Iceplex , July 19 - 23 |
| O Binghamton, NY |
$275.00
|
Chenango Ice Rink , July 19 - 23 |
| O Niagara Univ. , NY |
$260.00
|
Dwyer Arena, July 19 - 23 |
| O Pittston, PA |
$335.00
|
Revolution Ice Centre-Pittston, July 26 - 30 |
| O Strongsville, OH |
$315.00
|
Hoover Arena/Ice Land, USA, July 26 - 30 |
| O Charleston, SC |
$350.00
|
Carolina Ice Palace, July 26 - 30 |
| O York, PA |
$335.00
|
York City Ice Arena, Aug. 2 - 6 |
| O Columbus, IN |
$325.00
|
Hamilton Ice Center Arena , Aug. 2 - 6 |
| O Alexandria, VA |
$445.00
|
Mt.Vernon Rec. Center, Aug. 2 - 6 |
| O Cicero, NY |
$295.00
|
Cicero Twin Rinks, Aug. 9 - 13 |
| O Shelton, CT |
$465.00
|
The Rinks at Shelton, Aug. 9 - 13 |
| O Rockville, MD |
$455.00
|
Rockville Ice Arena, Aug. 9 - 13 |
| O Rockville, MD |
$455.00
|
Rockville Ice Arena, Aug. 16 - 20 |
| O Rochester, NY |
$325.00
|
Sports Centre @ MCC, Aug. 16 - 20 |
| O Oaks, PA |
$375.00
|
Oaks Center Ice Arena, Aug. 16 - 20 |
| O Ithaca, NY |
$355.00
|
"The Rink" (Lansing) , Aug. 23 - 27 |
| O Buffalo, NY |
$275.00
|
Leisure Rinks, Aug. 23 - 27 |
| O Reisterstown, MD |
$400.00
|
Reisterstown Sportsplex , Aug. 23 - 27 |
| O Clifton Park, NY |
$275.00
|
Clifton Park Ice Arena, Aug. 30 - Sept. 3 |
| O Niagara Univ. , NY |
$260.00
|
Dwyer Arena , Aug. 30 - Sept. 3 |
Camp Tuition, Is Based On Ice Prices, In Each Individual City!
| Available
Discounts (Please Mark Your Discount for Credit - One Discount Max. Per Application) |
|
O 7% Very Early Bird Discount (Full/One Time) payment before December 31/09 |
| O 5% Early Bird Discount (Full/One Time) payment before March 15/2010 |
| O 5% Family Discount (2 or more family members-must be faxed/mailed together) |
| O 7% Group Discount (7 or more players in a group-must be faxed/mailed together) |
|
Please Register My Son/Daughter For The following Extras; O DVD Professional Skill Analysis (Individual Analysis) ($15.00) |
| O DVD Game-Tape Analysis (Group Analysis) ($10.00) |
| O "Youth Meal" - Lunch Program ($35.00) |
|
O "Big Kid Meal" - Lunch Program ($46.00) **NOTE: (Rockville Students Only) - A $10.00 Catering Surcharge will be added to your lunch program (Youth or Big Kid Meal). |
| How did you hear about
the Sport International Hockey Academy? O Returning O Recommendation O Amer. Hockey Magazine O Rink Display O Mail O Internet O SIHA Regional Director |
| Additional Brochure Request: | |
| O Free Summer Camp Brochures For Friends #________ | |
| Please Indicate Your Method and Amount
of Payment For Our 2010 Instructional Tour |
| O Check/Money Order: $____________________ |
| O Visa
O Master Card
O Discover: $____________________ (50% Tuition Deposit Minimum) Card # __ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __ Exp. Date: __ __ / __ __ Credit Card Holders Name: _____________________________________ Authorized Signature: _________________________________________ |
|
Waiver Claim: Acknowledging that
ice hockey is a contact sport, I agree that Sport International, Inc.
its agents, servants and employees shall not be liable to me for any injury
or damage resulting directly or indirectly from my participation in ice
skating and ice hockey, whether incurred on the ice or otherwise in or
about the buildings. I further agree that I discharge Sport International,
Inc. its agents, servants and employees from all actions, claims and demands
I may have for any injury or damage. I understand that my said agreements,
release and discharge shall bind by heirs, legal representatives and assigns
and shall insure to the benefit to Sport International, Inc., its agents,
servants and employees and their successors and assigns. It is further
agreed that Sport International, Inc. does not and shall not be considered
to guarantee/warrant such equipment as may be used in the conducting of
said program. I also give my consent to the Sport International Hockey
Academy to treat my son/daughter at their discretion, in case of any emergency
incident that may arise throughout the instructional week. Sport International,
Inc., reserves the right to use any pictures & videos taken during
the program for research, instruction and/or advertising. X___________________________________________ Date: ____________________ |
| Head Office: (800) 724-6658
• Fax#: (585) 865-1802 • The Sport International Hockey Academy 3800 Dewey Avenue, #212, Rochester, NY 14616 |