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Application

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August 15th 2004 thru August 19th, 2004
Registration Deadline ASAP

Last __________________________ First _____________ Middle ____________
Address ______________________  City/State/Zip _________________________
Present Team __________________ Highest Level of Competition ______________
Telephone ____________________ D.O.B. ___/__/_____ Shirt Size ____________
Cost of School: $285.00    $100.00 Deposit required with application. Balance due August 9th.

Amount Enclosed: $____________
Please make checks payable to Northstar Goalie School  and submit to below address.

I hereby assume all risks and hazards incidental to participation in any and all activities of the Northstar Youth Forum and related programs.  I hereby absolve, indemnify and agree to hold harmless the Northstar Youth Forum and their coaches out of injury to the above named skater.

Signature of Parent or Guardian _____________________________  Date ________

Mail to: Northstar Goalie School, P.O. Box 856, Northboro, MA 01532-0856

Send mail to MrsLobi@aol.com with questions or comments about this web site.
Copyright 2008
Last modified: February 12, 2008