201730th Annual

BLUELINEHockey School

Moorhead Youth Hockey Arena707 Main Ave SE, Moorhead, MN

June 5th through

June 29th

Player’s Name:

Parent’s Name:

Address:

City: State: Zip:

Home Phone:

Other Phone #’s:

Email:

Age: Preferred Position:

EMERGENCY NUMBER: [Name and # to call if no answer at above #’s]

Name:

Phone:

SESSION ICE TIME: [Please check your choice]

c Bantam S 8:00-10:00 am c PeeWee N 8:30-10:30 am c High School S 10:15-11:45 am c Squirt N 10:45-12:45 pm c PeeWee S 12:00-2:00 pm c Mite S 2:15-3:45 pm c Squirt N 1:00-3:00 pm c Mite N 3:15-4:45 pm

DISCOUNTS: [Please check if they apply]

c Two family Members - Receive $30.00 off total fee. c Three family Members - Receive $90.00 off total fee. c Four or more family Members -Talk to camp directors

DEPOSIT: A deposit of $100.00 is due with application. This is non-refundable. Final payment must be made on or prior to first ice session participation.

Medical Information & Waiver on reverse side:This sheet must be completed before application will be accepted.

OFFICE USE ONLY:

Starting Amount

Discounts

Deposit

Balance

Payment

Balance

Date

Ck#

Date

Ck#

Make Checks payableand send application to:

BlueLine Hockey School4403 5th Street SouthMoorhead, MN 56560

[Detach & Mail with Check]

Girls players are invited to enroll and skate at the Mite/8U and Squirt/10U levels. We are not offering a 12U and older

camp this year, however we can refer you to local girls camps being offered.

If you have additional questions regarding the correct placement or girls camps please call

Brad (218)233-1017 or Jon (701)371-8860.

GIRLS BLUELINE HOCKEY SCHOOL

n Weekends Open for Summer Activities n Local, Qualified, Caring Coaches n 29 Years Proven Results

V I S I T U S AT w w w . b l u e l i n e h o c k e y s c h o o l . c o m

WHY BLUELINE HOCKEY SCHOOL? n Four Weeks in Length n 16 Ice Sessions n Emphasis on Skill Development n Daily Scrimmages

Questions? Call Jon Ammerman (701) 371-8860 Brad Franklin (218) 233-1017 jon@bluelinehockeyschool.com brad@bluelinehockeyschool.com

(Each parent is responsible for providing adequate insurance coverage as a condition for enrollment.)If yo

u ca

n ha

ndle

the

puck

, pas

s th

e pu

ck, s

hoot

the

puck

, a te

am n

eeds

you

. If y

ou c

an h

andl

e th

e pu

ck, p

ass

the

puck

, sho

ot th

e pu

ck

plus

ska

te, a

team

nee

ds a

nd w

ants

you

. No

mat

ter h

ow fa

st y

ou c

an s

kate

, if y

ou c

an’t

hand

le th

e pu

ck w

ith y

our h

ead

up, i

f you

can

’t se

e th

e ic

e, y

ou w

ill n

ot p

lay

at a

ver

y hi

gh le

vel.

That

is w

hy w

e sp

end

out t

ime

work

ing

on th

ose

basi

cs o

f stic

k ha

ndlin

g, p

assi

ng, s

hoot

ing

and

skat

ing.

Tha

t is

why

we tr

y to

scr

imm

age

ever

yday

. We

want

you

to b

e a

play

er. W

e wa

nt y

ou to

be

a be

tter p

laye

r. Ov

er 3

0 ye

ars

we

have

hel

ped

prod

uce

som

e pr

etty

goo

d pl

ayer

s, s

ome

real

goo

d pl

ayer

s an

d so

me

world

cla

ss p

laye

rs. Y

es, w

e ar

e a

little

old

fash

ione

d; w

e be

lieve

in b

aseb

all,

golf,

swi

mm

ing,

etc

. Blu

elin

e is

4 w

eeks

onc

e a

day,

beca

use

we k

now

mor

e wi

ll be

reta

ined

than

if w

e ha

d 4

one-

week

se

ssio

ns. W

e ar

e no

t int

o th

e of

f-ice

act

iviti

es o

r the

dry

land

pro

gram

s, b

ut th

ey a

re a

vaila

ble

at th

e bu

ildin

g if

you

are

inte

rest

ed in

them

. W

e co

uld

likel

y ha

ve a

real

ly in

tere

stin

g co

nver

satio

n ab

out s

umm

er tr

avel

hoc

key

and

sele

ct te

ams

as w

e kn

ow th

e pu

ck w

ill b

e on

you

r st

ick

mor

e in

one

day

of B

luel

ine

than

in a

wee

kend

tour

nam

ent.

BLU

ELIN

E BE

LIEF

S

visi

t us

at w

ww.b

luel

ineh

ocke

ysch

ool.c

om

Fees

Squi

rt, P

eeW

ee, B

anta

m w

hich

are

2

hour

ses

sion

s da

ily c

ost $

450.

00

Mite

, Hig

h Sc

hool

whi

ch a

re 1

.5 h

our

sess

ions

dai

ly c

ost $

340.

00

A $1

00.0

0 no

n-re

fund

able

de

posi

t is

req

uire

d at

sig

n up

. Ba

lanc

e is

du

e at

sta

rt of

cam

p un

less

oth

er

arra

ngem

ents

are

mad

e pr

ior.

Dis

coun

ts g

Two

fam

ily M

embe

rs

-

Rece

ive

$30.

00 o

ff to

tal f

ee.

g

Thr

ee fa

mily

Mem

bers

-

Rece

ive

$90.

00 o

ff to

tal f

ee.

g

Fo

ur o

r mor

e fa

mily

Mem

bers

-T

alk

to c

amp

dire

ctor

s.

Blu

eLin

e N

otes

:Cl

ass

Size

: We l

imit c

lass s

ize an

d are

we

ll-pr

epare

d with

expe

rienc

ed co

ache

s to

keep

sess

ions m

oving

. At th

e Ban

tam an

d Hi

gh S

choo

l leve

ls, th

ere is

only

one s

essio

n av

ailab

le, so

sign

up ea

rly.

PeeW

ee, S

quirt

s &

Mite

s: Tw

o tim

e ch

oices

. This

may

allow

the o

ppor

tunity

to

doub

le up

and m

ake u

p ses

sions

you m

ight

miss

.Hi

gh S

choo

l: If y

ou ne

ed to

miss

a we

ek of

ca

mp t

o atte

nd ei

ther a

USA

Hoc

key C

amp o

r M

odel

Cam

p, yo

ur fe

es w

ill be

pror

ated.

Talk

to

Brad

or Jo

n dur

ing re

gistra

tion t

o get

appr

oval.

Girls

: See

othe

r side

of br

ochu

re.Go

alie

s: Lim

ited

to 4

goali

es p

er se

ssion

. W

e off

er a

price

red

uctio

n of

up to

30%

for

perfe

ct att

enda

nce.

Call

Jon

701-

371-

8860

or

Brad

218

-233

-101

7 fo

r det

ails

.

SESS

ION

IC

E T

IME

GROU

P RI

NK

ICE

TIM

E Ba

ntam

S

8

:00-

10:0

0 am

PeeW

ee

N

8:3

0-10

:30

am

High

Sch

ool

S

10:

15-1

1:45

am

Squi

rt

N

10:

45-1

2:45

pm

PeeW

ee

S

12:

00-2

:00

pm

Mite

S

2

:15-

3:45

pm

Squi

rt

N

1:0

0-3:

00 p

m

Mite

N

3

:15-

4:45

pm

Dai

ly S

kill

Wor

k

g

Puck

Han

dlin

g

g

Skat

ing

(incl

udin

g ac

cele

ratio

n,

bala

nce,

pow

er, u

se o

f edg

es)

g

Pa

ssin

g &

Rec

eivi

ng

g

Shoo

ting

& S

corin

g

g

Chec

king

Dai

ly S

crim

mag

es

g

Posi

tiona

l Pla

y

(fo

rwar

ds, d

efen

se, &

goa

lies)

g

Sy

stem

s Pl

ay

(fo

re-c

heck

ing,

bre

akou

ts,

defe

nsiv

e co

vera

ge)

Sche

dule

sHo

ckey

Sch

ool r

uns

Mon

day

thro

ugh

Thur

sday

eac

h we

ek. N

o ho

ckey

sch

ool

on F

riday

s an

d we

eken

ds.

Scho

ol D

irec

tors

: Jon

Am

mer

man

& B

rad

Fran

klin

Blue

line

Hock

ey S

choo

l Sta

ff:

Jon

Amm

erm

an

- Moo

rhea

d Hi

gh S

choo

l Hea

d Co

ach

Tony

Kun

ka

- Moo

rhea

d Hi

gh S

choo

l Ass

ista

nt C

oach

Ror

y Sa

ndvi

g - F

orm

er M

oorh

ead

High

Sch

ool A

ssis

tant

Coa

ch

Der

ek T

hom

pson

- M

oorh

ead

High

Sch

ool J

V He

ad C

oach

Mat

t Cul

len

- Pitt

sbur

gh P

engu

ins

Mar

k Cu

llen

- E

urop

ean

Pro

Leag

ue

Chri

s Va

ndeV

elde

-

Phi

lade

lphi

a Fl

yers

Will

Bor

gen

- S

t Clo

ud S

tate

Mic

hael

Bitz

er

- B

emid

ji St

ate

Brya

nt C

hris

tian

- A

mer

ican

Inte

rnat

iona

l

PERMANENT WAIVER That I / we: (Parent or Guardian Name)

the undersigned, parent or guardian of

, do hereby(Please Print Athlete’s Name)

agree for said child and his/her heirs, executors, administrators, and assigns of said child, that neither the BlueLine Hockey School, Inc. (The “Company”.), nor any of its officers, directors, instructors, employees, or shareholders shall be held responsible or liable for any negligence implied or otherwise, or personal injury, or death, or property loss, or damage suffered or sustained by said child in connection with or arising out of or resulting from any or all youth hockey activities engaged in by said child and absolve and release in the Company, its officers, directors, instructors, employees, and shareholders, and/or from all liability thereof, and further, I/we do hereby consent and agree for said child his/her heirs, executors, administrators, and assigns, not to sue, arrest, attach, or prosecute the Company, its officers, directors, instructors, employees, or shareholders for or on account of any such personal injury or death or property damage or loss, it being my/our express intent and purpose to bind said child’s heirs, executors, administrators and assigns.

Date this Day of 2017.

Parent or Guardian: (Parent or Guardian Signature)

MEDICAL INFORMATION:In case of emergency, I/we hereby authorize emergency treatment

and/or care of: (Please Print Athletes Name)

If there is an emergency and I/we cannot be reached, please contact the following person, who is hereby authorized to act in my/our behalf.

Name:

Address:

Telephone Number:

Health & Accident Insurance Company:

Policy Number: