Sign Up for Youth Return to Hockey Program *

First Name

Last Name

Parent's Phone Number & Emergency Contact *

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Phone Number *

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Programs (Pick 1): *

3 PACK - $51

6 PACK - $96

12 PACK - $180

Waiver *

Yes, I agree to Raised Athletics Liability Waiver & Release Form

No, I do not agree to Raised Athletics Liability Waiver & Release Form