Fall Roller Hockey Registration

Fall Roller Hockey Registration

For 2nd-6th graders with Coaches Tristan James & Karl Cody
Oct 29 - Nov 26, 2025

Wednesdays, 3:45-5pm / Saturdays, 9-11am

At the Pig Palace at the San Miguel County Fairgrounds

$45 registration fee

Nine sessions plus roller blades & safety equipment provided!

• LIMITED TO 15 PARTICIPANTS •

PARENTS / GUARDIANS:
Payment by cash, check, or card will be collected at the FIRST session.
Waivers MUST be signed at the FIRST session.
CHILD 1 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade
Any medical conditions?
If yes, explain
CHILD 2 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade
Any medical conditions?
If yes, explain
CHILD 3 Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade
Any medical conditions?
If yes, explian
Paren/Guardian Name*

First NameLast Name
Parent/Guardian Phone*

Area CodePhone Number
Parent/Guardian Email*
example@example.com
As the parent/guardian of the above named child(ren), I give permission for a NPRD Staff Person or Coach to pick up the participants from the Norwood Public School and walk them to the Roller Hockey Rink at the Fairgrounds as needed.
Agree to allow pickup of child(ren) from school?

Accept
Should be Empty: