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Please print and
complete this form. Fax it (817-2405) or deliver
it to Jennifer Blanchard, Hockey Coordinator,
Charlottesville Ice Park, 230 W. Main Street, Charlottesville, VA 22902
Thank You!
CHARLOTTESVILLE
ICE PARK
Classes Begin
Saturday, September 8th and Monday, September 10th, 2007
THIS WILL BE A
SIX WEEK SESSION FOR ONLY $75.00
2007
HOCKEY CLASS REGISTRATION FORM
_____Mighty Mites $75.00* (Saturdays 9:30AM OR
Mondays 5:30pm Please circle one.)
____Youth Basic
Hockey $75.00* (Saturdays Only at 10:15AM)
____Adult Basic
Hockey $75.00* (Mondays Only at 6:00PM)
____Equipment Rental $20 ____Helmet Only Rental $10
Returning Student Discount $5.00____
Total Amount
Due $__________
Player's Name
__________________________________ Date of Birth
______________
Address
_______________________________________ Phone
(H)________________
City/State/Zip
___________________________________
(W)________________
E-mail Address
_________________________________________________________
Payment
___Check ____Credit Card (MC. Amex, Visa, Discover)
___Cash (In Person Only)
Credit Card #
_________________________________________ Expiry
Date_________
Name on Card
_______________________________________ Amount
$___________
I authorize
the Charlottesville Ice Park to charge my credit card for
the amount shown above:
__________________________________________________________
(Signature of
Card Holder required)
*PLEASE NOTE:
All class fees include six classes, skate rental and
three
public skating passes.
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