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Please read and fill out the following form in order to participate in our activity.

In consideration of the participant and/or his/her parent/guardian being permitted to register the
participant, and participate at The Rinks at Summit Centre “Nexlevel Hockey” Development Skates the
undersigned acknowledges, appreciates, and agrees that:

1) The risk of injury from activities involved in this program is significant, including the potential for
permanent paralysis and death, and while particular rules, equipment, and personal discipline may
reduce this risk, the risk of serious injury does exist.

2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown even arising
from the negligence of the releasees or others, and assume FULL responsibility for my participation.
3) I willingly agree to comply with the stated and customary terms and conditions for participation. If
however I observe any unusual significant hazards during my presence or participation, I will remove
myself from participation and bring such to the attention of the nearest official immediately.

4) I, for myself and on behalf of my heirs, assign personal representatives and next of kin, we HEREBY
FOREVER RELEASE AND HOLD HARMLESS; Mike Nolan, Nexlevel Hockey, G. G. Ice Centre Ltd. AND
The Rinks at Summit Centre, its directors, instructors, employees and any person or corporation herewith
from all manner of action, injury, damages, costs, claims or demands which we shall or may hereafter
have, suffer or receive by reason of such participant in any programs or camps. The release shall be
binding on our their, assigns, executors and administrators.

5) I further consent to Mike Nolan, Nexlevel Hockey, G.G. Ice Centre Ltd and The Rinks at Summit Centre
to use any pictures/video taken of the participant during any programs or camps for marketing and promotional.

6) I acknowledge and willingly accept that all sales are final. If I have registered but cannot attend a
session a refund will only be issued if a valid doctor’s note is provided confirming inability to participate in
the respective session.

Thanks for submitting!


This is to certify that I, as parent/guardian with legal responsibility for this participant, I consent and agree to his/her release as provided above of all the releases. I release and agree to indemnify the releases for any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

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