Alpine Ice Arena

Learn to Play Hockey Registration

Return this portion with payment

Name _________________________ Age ____ Date of Birth ___/___/____ Phone _______________
Address ________________________________ City _________________ State ______ Zip _________
Class Name (level & day) _________________________________ Dates _________________________
Parent/Guardian signature _______________________ Amount ______ Cash _______ Check # _____
Registrant acknowledges that ice skating can be dangerous; therefore, each skater skates at his or her own risk. No skater can be on the ice unless payment is received before class --- NO REFUNDS ---	Returning Alpine Skate School student ( )Y ( )N
	Visa/Master Card # _________________________
	Payment MUST accompany registration form	Exp. date ___________