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THE SPORT INTERNATIONAL HOCKEY ACADEMY Email address:______________________________________________ Academy
Hockey Position: Forward Defense Goalie Doctor's Name:____________________________ |
| City/State | Price | Arena, Date |
| O Raleigh, NC | $65.00 | The Rec. Zone, November 23 - 24 |
| O Fort Bragg, NC | $TBA | Cleland Multi-Sports Complex, TBA |
| O Greensboro, NC | $70.00 | The Ice House of Greensboro, Nov. 24 - 25 |
| O Richmond, VA | $90.00 | Richmond Ice Zone, Nov. 24 - 25 |
| O Niagara Univ. , NY | $60.00 | Dwyer Arena, Dec. 26 - 27 |
| O Cincinnati, OH | $65.00 | Sports Plus Arena, Dec. 27 - 28 |
| O Rochester, NY | $70.00 | ESL Sports Centre, Dec. 27 - 28 |
| O Dale City, VA | $75.00 | Prince William Skate Quest, Dec. 27 - 28 |
| O Dayton, OH | $70.00 | South Metro Ice, Dec. 28 - 29 |
| O Alexandria, VA | $80.00 | Mt. Vernon Rec. Center, Dec. 28 - 29 |
| O Baltimore, MD | $85.00 | Ice World, Dec. 30 - 31 |
| O Buffalo, NY | $55.00 | Holiday Twin Rinks, Dec. 30 - 31 |
| O Ithaca, NY | $60.00 | "The Rink" - Lansing, Dec. 30 - 31 |
| O Strongsville, OH | $60.00 | Ice Land, USA, Dec. 30 - 31 |
| Available
Discounts (Please Mark Your Discount for Credit - One Discount Max. Per Transaction) |
| O 5% Family Discount (2 or more family members) |
| O 5% Returning Student Discount |
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Please Register My Son/Daughter For The following Extras; O DVD Professional Skill Analysis ($15.00 additional cost) |
| Additional
Sport International Offers: (Please Send Me Additional Information) |
| O Clinic Brochures For Friends #_____ |
| O 50 Fast & Fun Hockey Drills CD (for coaches) |
| O Skate Weights Training Equipment |
| O Coach-Mate Dry Erase Drill Boards (for coaches) |
| O Power Puck (contains radar LCD) |
| O Shooter Tutor Target |
| O Speed-Chek Radar Gun |
| O Sport Int'l Player/goalie Evaluation System (for coaches & organizations) |
| Please Indicate Your Method and Amount of Payment For Our 2007 Winter Clinic |
| O Check/Money Order: $____________________ |
| O Visa
O Master Card
O Discover: $____________________ Card # __ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __ Exp. Date: __ __ / __ __ Credit Card Holders Name: _____________________________________ Authorized Signature: _________________________________________ |
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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 me 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. Signature: __________________________________________________ Date: ____________________ |
| Head Office: (800) 724-6658
• Fax#: (585) 865-1802 • The Sport International Hockey Academy 3800 Dewey Avenue, #212, Rochester, NY 14616 |