The KPS Elite Training System REGISTRATION FORM

Click here for program description. For more information call (734) 433-4445 or email info@keilsk8.com.

Registration deadline: May 1, 2008. Print this form and mail with your check to: Keil Power Skating, P.O. Box 2823, Ann Arbor, Michigan 48106

Name___________________________________________________ Birthdate____________________________

Address_________________________________________________ City/State/Zip________________________

Parent’s Names _______________________________________ Email __________________________________

Phone (H)________________________ (W)_________________________ (C)_______________________

Emergency Contact____________________________________ Phone______________________________

I am registering for the following program:

___ KPS Novice Level -- $600 ($200 due with registration)

___ KPS Level IA -- $900 ($400 due with registration)

___ KPS Level IB -- $900 ($400 due with registration)

___ KPS Level IC -- $1100 ($450 due with registration)

___ KPS Level II -- $1100 ($450 due with registration)

___ KPS Level III -- $1300 ($450 due with registration)

PLEASE CHECK ONE

_____Also, I have included a check for $50 / $75 payable to Hockey Masters to cover my annual membership. Membership is $50 for individual and $75 for family. (more info)
_____I am already a member of Hockey Masters.

Liability Waiver

I, __________________________________, parent/guardian of _____________________________ participant, hereby recognize that participation in the sport of ice hockey, ice skating, or off ice strength training and conditioning can be hazardous, even dangerous, and can result in minor or serious injury, even death. For these reasons, I hereby acknowledge that I understand the risks involved in skating, hockey, and off-ice strength and conditioning, and, should a medical emergency arise, I grant full authorization for medical treatment to 911 Emergency staff on call. By signing this waiver I also agree that in no way will I hold the Arctic Coliseum, Keil Power Skating, Inc., One on One Skill Development, Inc., Carrie Keil, Dave Debol, Darryl Nelson, Kirk Culik, or any other professional instructors liable for any such injuries should they occur. I have fully read this waiver and I acknowledge a complete understanding of the contents of this waiver.

Signed______________________________________ Date__________________________