

| David Roberts Youth Winter Hockey Clinic | |
| When: | December 26th-29th, 2007 8-9:50am |
| Registration & Fees: | $149 for all four days Cash or check only please. |
| Classifications: | Mites, Squirts, Pee-Wees, Bantams (open to all ages) |
| Equipment: | Full hockey equipment required plus gym shoes. |
Brochures and registration forms are available inside Yost Arena or by contacting the Yost office at (734) 764-4600 or yostice@umich.edu |
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David Roberts Youth Winter Hockey Clinic
City:_____________________ State:___________ Zipcode:___________________
Home Phone:(___)_____________________ E-mail:_________________________
Parent or Guardian's Name:_____________________________________________
Contact's Work or Daytime Phone Number:_________________________________
Emergency Phone Number: (___)_________________________________________
Age:________ Position:______________
Last Season's Division & Classification:_____________________________________
Cost is $149 (US Funds Only) Enrollment is limited!!! Please send (Check or Money order) payable to:
David Roberts Youth Hockey School 1000 South State Street
Ann Arbor, MI 48109
(734) 764-4600
AGREEMENT TO PARTICIPANT:
I/We agree to release Yost Ice Arena, David Roberts Youth Hockey Scchool, The University of Michigan, The University of Michigan Athletic Department and its employees from all claims, actions, causes of actions, or injury resulting directly from the participation of persons in the program. I further agree to indemnify and save harmless parties from all claims, damages or demands, including all costs and expenses incurred in defending any such claim or action.
I have read the release and understand that this is a full release of all claims for injury and damages sustained in Yost Ice Arena and have read over the agreement and understand the responsibilities I have assumed there under.
____________________________________ Particpant's Signature __________________Date
____________________________________ Parent or Legal Guardian's Signature _________________________ Date
| David Roberts Adult Hockey School |