You may print this registration form and mail or fax it with payment, or contact 

us for more information.

Address: Maximum Performance 

             20726 Jayhawk Dr. 

             Chugiak, AK 99567

Fax:(907)688-9454

Name:_________________________________

Date of Birth:___________________________

Address:_______________________________ 

_______________________________________

Phone:_________________________________

Parent Name:___________________________

Emergency Contact:______________________

Emergency Phone:_______________________

Eagle River Defensemen's Camp (Squirt/Peewee) _____

Wasilla Defensemen's Camp (Squirt/Peewee) _____

Payment Method

Check___    Amount Enclosed $________

Make checks payable to: Maximum Performance.

Visa___    MC___      Amount Charged $________    

Credit Card Number__________________    

Name On Card_______________________

Expiry: Month____    Year____

Card Holder Signature______________________________

Release and Indemnity: I hereby release Maximum Performance Hockey 

Schools from liability or responsibility for any accident that may occur 

during the hockey school.

____________________________________________

Parent/Guardian Signature

If you would like Maximum Performance Schools to hold a spot for your child, a 50% deposit

is required, with the balance due at camp.  If this presents a problem, please call Rodney

Wild at (907)688-9453 or send an email and we will try to find an alternative payment

schedule.  There will be a $25 fee attached to all NSF checks.  If your child drops out during

the camp (due only to injury, sickness, or family emergency) your refund will be prorated per

days of attendance.

Maximum Performance Hockey Schools reserves the right to remove a student from the camp

if, in the opinion of the staff, the student is disrupting the educational atmosphere of the class

and/or is behaving in such a manner that the staff is concerned with the safety of that player

or other players.