Today's Date: MM/DD/YY *First name: *Last name: Age: D.O.B.: MM/DD/YY Address: City: Zip: Home #: xxx-xxx-xxxx Office#: xxx-xxx-xxxx Cell #: xxx-xxx-xxxx Email:
SELECT ONE OR MORE OPTIONS BELOW: ___________________________________________ Summer Show Camp - Peter Pan - 2010 June 7 - 18 (9am - 3pm / M-F)
$400 Full Camp: June 7 - June 18 (For LTS Students enrolling prior to April 1, 2010) $450 Full Camp: June 7 - June 18 (For non-LTS Students enrolling prior to April 1, 2010) $500 Full Camp: June 7 - June 18 (anyone enrolling after April 1, 2010) $25 After Care: Per day (supervised after-care from 3-5) $100 After Care: Entire Show Week (supervised after-care from 3-5) For Groups of 10+ Please Call for Pricing (Jeanette Neal - 214-720-8011) Show Tickets Choose Number of Tickets 1 ticket $12 2 tickets $24 3 tickets $36 4 tickets $48 5 tickets $60 6 tickets $72 7 tickets $84 8 tickets $96 9 tickets $108 10 tickets $112 On-Ice Seating - June 17- Day Performance Choose Number of Tickets 1 ticket $10 2 tickets $20 3 tickets $30 4 tickets $40 5 tickets $50 6 tickets $60 7 tickets $70 8 tickets $80 9 tickets $90 10 tickets $100 Off-Ice Seating - June 17- Day Performance Choose Number of Tickets 1 ticket $12 2 tickets $24 3 tickets $36 4 tickets $48 5 tickets $60 6 tickets $72 7 tickets $84 8 tickets $96 9 tickets $108 10 tickets $112 On-Ice Seating - June 18- Evening Performance Choose Number of Tickets 1 ticket $10 2 tickets $20 3 tickets $30 4 tickets $40 5 tickets $50 6 tickets $60 7 tickets $70 8 tickets $80 9 tickets $90 10 tickets $100 Off-Ice Seating - June 18- Evening Performance
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Summer Camp 2010
Payment Method: CHARGE (secure site) Card Holder Name: Master Card American Express Visa
Credit Card Number: - - - Exp. Date: Month 01 (Jan) 02 (Feb) 03 (Mar) 04 (Apr) 05 (May) 06 (Jun) 07 (Jul) 08 (Aug) 09 (Sep) 10 (Oct) 11 (Nov) 12 (Dec) Year 2008 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Total Amount to be charged to card: $ No refunds or credits for lessons missed due to the fault of the skater.
In consideration of being allowed to participate in any way in the athletic/sport program, related events and activities, the undersigned acknowledges, appreciates and agrees that;
1. The risk of injury from the activities involved with this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce that chance, the risk of serious injury does still exist: and
2. I knowingly and freely assume all such risk, both known and unknown, even arising from the negligence of the releases or others, and assume full responsibility for my participation: and
3. I willingly agree to comply with the stated customary terms and conditions for participation. If however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately: and
4. I for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Americas Ice Garden and Rink Management Services, their officers, officials and or employees, other participants, sponsoring agencies, sponsors, advertisers and if applicable, owners lessors of the premises used to conduct the event ("releases"), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise.
Name of participant or participants legal guardian if under 18. Printed Name:
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY TYPING NAME, AND SELECT AGREE FREELY WITHOUT ANY INDUCEMENT.
AMERICAS ICE GARDEN 700 NO. PEARL - DALLAS, TX 75201 214.720-8080 - FAX: 214-720-8089 WWW.AMERICASICEGARDEN.COM