EmailMe Form - Learn to Skate/Learn to Play Winter 22-23

Please note that payment has been disabled on this form.
You may notify the owner and continue to submit the form.

Player's Name *
First Last
Player Birth Date *
MM / DD / YYYY
Parent/Gaurdian *
First Last
Parent/Guardian Phone *
### - ### - ####
Parent/Guardian Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Is this player on any medication or under a Physicians care?
No
Yes
If Yes please explain.
Release Form: Must be read and signed by parent or guardian As parent/guardian of the above named child, I hereby grant permission for him/her to participate in the activities of Real Speed Learn to Play. I hereby waive, release and forever discharge said Real Speed Sports, it’s officers, members, agents, representatives and employees from all claims and demands which I, my heirs, executors and administrators, and those of the above named child have or may have by reason of any personal injury or injuries, property damage or damage of any nature whatsoever resulting from the participation of the above named child in the activities of Real Speed Sports and any consequences arising there from. I understand that I must pay the required player fee for the registration period for my child to continue to participate in the program.
Consent by your Signature and Submitting.
Clear