Place: RI Sports Center – Rte. 146

1. MITE INSTRUCTIONAL Cross Ice Hockey League 2014 – 2015 Fall / Winter Season • Place: RI Sports Center – Rte. 146 • Date: Session 1: Sept 21st – Dec 21st (No session 10/12, 11/9) • Session 2: Jan 4th - Mar 29th (No session 1/18) • Time: Sundays, 7:40am • Cost: $99 per session ** FREE EVALUATION – SUNDAY, SEPT 7, 8:20am ** This instructional session is designed for skaters new to playing hockey and will ease them into the game. The program will use a cross ice 3 on 3 format in which all skaters get equal playing time and will develop the knowledge to move ahead to the Mite Half Ice leagues. Please make checks payable to: Providence Capitals P.O. Box 37 Manville, RI 02838 (Credit card payment available at the rink or by completing authorization form online) Name: ___________________________________ Date of Birth: ______________ Address: ____________________________________________________________ City/Town: ___________________________ State: __________ Zip: __________ Telephone: __________________________ Skating Experience: ______________ Email Address: ______________________________________ 2014-15 Mite Instr Release of Liability/Acknowledgment of Risk: In conjunction with my son or daughter’s participation in events sponsored by the Providence Capitals. (“the Company”). I understand that participation in or observation of ice hockey may result in serious injury including permanent paralysis or death. I recognize and assume this risk and understand and agree that neither the company nor any of its officers, directors, shareholders, employees, agents, coaches or referees shall be responsible for any accidents, injury (including paralysis and/or death), loss of equipment or any other costs, expenses, damages or losses in connection with such participation. I hereby represent to the Company that my son or daughter is in good health and is fully able to participate in the rigorous physical activity of the Company sponsored ice hockey program. In the event of injury or illness, the Company has my permission to provide, or make arrangements for the provisions of, emergency first aid. ___________________________________________________________________________________________________ Parent/Guardian Signature Date For details, please log onto providencecapitals.com