Mini-Mite
Born 2010 or Later

$ 2,195.00

Ages: 4-5-6

Birth Year: 2010 or later

Season: Late October thru mid-March

Practices: 30-35 60-minute practices held at Lasker Rink in Central Park

o Sundays @ 2PM

o Mondays @ 4:10PM

Games: Approximately 6 games will be played at Lasker Rink, plus end of season Lasker Cup tournament. Games will be played cross-ice, in accordance with USA Hockey guidelines.

Capacity: 24 players

Player's First Name

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Player's Last Name

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Available Leagues

by age group

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USA Hockey #

What is this?

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Date of birth (mm/dd/yy)

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Gender

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Parent/Guardian 1 Name

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Parent/Guardian 1 Email

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Parent/Guardian 1 Phone

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Parent/Guardian 2 Name

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Parent/Guardian 2 Email

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Parent/Guardian 2 Phone

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Alternate Emergency Phone Number

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Doctor's Name

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Doctor's Number

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Allergies

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If Yes Please Describe

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Medication(s)

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School

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Additional Comments

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Jersey Number Preference #1

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Jersey Number Preference #2

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Jersey Number Preference #3

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Emergencies

If an emergency illness or injury occurs, I hereby authorize NyICECATS to treat and/or send my child listed above to a physician or hospital and authorize the necessary treatment. I understand that every attempt will be made to contact parents or the emergency contact. I also authorize the emergency contact listed above to pick up my child in case of emergency. All information on this form is complete, true and accurate to the best of my knowledge.

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USA hockey waiver of liability

I have read and accept the USA hockey waiver of liability

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Mini-MiteBorn 2010 or Later

Mini-Mite
Born 2010 or Later