Fall'26 Roller Hockey Registration

Fall Roller Hockey Registration

For 2nd-7th graders with Coach Karl Cody
Oct 14 - Nov 18, 2026

Wednesdays, 3:45-5:15pm / Saturdays, 9:30-11:30am

Except Saturday, Oct. 31

At the Pig Palace at the San Miguel County Fairgrounds

$40 registration fee

Ten sessions plus roller blades & safety equipment provided!

• LIMITED TO 15 PARTICIPANTS •

PARENTS / GUARDIANS:
Gear Set-up (req'd) Monday, Oct. 12 4-6:30 pm at the Livery.

Payment by cash, check, or card will be collected at the Gear Set-up session.
Waivers MUST be signed at the FIRST practice.
CHILD 1 Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade
Any medical conditions?
If yes, explain
CHILD 2 Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade
Any medical conditions?
If yes, explain
CHILD 3 Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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?
Should be Empty:

Fall Roller Hockey Registration