My History

There will be a limited number of participants so sign up early. Call me (258-6462) or email me (Madknuk@bis.midco.net) to hold your spot. For camp details please read below. Please print off the registration form below and make payment out to Madknuk Enterprises LLC and send it to Madknuk Enterprises LLC, 624 North 21st Street, Bismarck, ND 58501.

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Name____________________________ Address_________________________________

City__________________________ State___________ Zip__________ DOB__________

Parents___________________________________ Phones_________________________

Email____________________________ Special Health Conditions____________________

Permanent Waiver: I/We, the aforementioned parents or guardian and minor child, recognize and acknowledge the fact that hockey is a sport in which there risks of injury to the participant. Because of this and desiring that the aforementioned minor participant in this summmer camp, as a participant, and in consideration of his/her enrollment, we agree that we shall indemnify and save Madknuk Enterprises LLC, its agents, officers, directors, instructors, employees, counselors, or shareholders harmless from any and all liability or damages arising directly out of or in conncection with his/her enrollment and/or participation in the above mentioned hockey camp.

Medical Release: In the event of injury to _________________________ while at camp, I hereby consent and authorize the administration of all treatments and tests that may be considered advisable or necessary by the emergency room physician or any other clinic physicians.

Insurance Company: __________________________ Policy #____________________

I understand as a condition of enrollment, I am responsible for providing medical insurance coverage for any medical expenses incurred. I hereby acknowledge the health of my child to be ready for hockey participation and training. A physical may be desirable.

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Parents/Guardian Signature

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