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  1. Mail-in registration
    • Complete the form below
    • Using your browser, print the completed form.
    • Include the non-refundable payment of $150 and send to:

      • Delaney Hockey
      9345 N. Harding
      Evanston, IL 60203

     

  2. Register online using the form below.

    • Enter in all information and submit the form by clicking on the 'submit registration' button.
    • Once the form is submitted, you will be directed to a confirmation page.
    • On the confirmation page, you can choose either to mail in a Personal check/Money Order or use PayPal for credit card payments.

 

Pro-rated fee and/or sibling discounts are available.
Contact Kevin Delaney directly through email after registering.
An adjusted invoice will be sent to you for payment.
click here to send Kevin e-mail


 

Ultimate Skills August Hockey Camp 2010 spaceAug. 23 - Aug. 27


* Players First Name:
* Last Name:
Address:
Address 2:
City:
State:    Zip:
e-mail:
* Phone: - - Home Work Cell
Phone: - - Home Work Cell
* Date of Birth: - -     (mm-dd-yyyy)
Position:     Shot: Left Right
Current Team:

 

Yes No - Does this child have any disabilities, handicaps, present injuries or limitations, allergies, hemophilia, heart condition, history of respiratory illness or any other significant medical condition?

 

If you are registering for a Skills Camp, please print the page AFTER pressing the "Submit Registration" button.   Sign the printed page and bring it with you on the first day of your training camp.

 

Liability Waiver / Consent to Treat

I agree that I shall provide health insurance to cover any personal injury and property damage sustained by the student/s while participating in any activities or while on the premises of the Delaney Ultimate Hockey Training Camp; the undersigned assumes all responsibility for any and all risk for damage or injury that may occur to the above named student/s as a participant in Delaney Ultimate Hockey Training Camp, including practices, games, skill sessions, clinics, and other activities related to the program. In consideration of such, the undersigned hereby releases and discharge the program, American Heartland Ice Arena, Kevin Delaney, it's operators, employees, agents, supervisors, instructors, and other players from all claims, demands, rights or cause of action present or future, whether known or anticipated and resulting from or arising out of or incident to the undersigned participation with the said program.

I give permission to have my child examined and treated by a qualified medical professional if he or she becomes injured in my absence.


Check here to acknowledge that all of the information entered above is accurate and that you agree with the above liability policy.