Learn the coolest moves from the Lightning Girls and perform at the

Learn the coolest moves
from the Lightning Girls and
perform at the February 6TH
game versus the St. Louis
Blues at 3:00pm!
•Open to girls ages 5 to 12
•Rehearsals are February 2ND &
3RD from 6:00pm - 8:00pm
•Performance February 6TH
Tampa Bay Lightning vs.
St. Louis Blues 3:00pm
•$50 terrace level &
$130 plaza level tickets
(t-shirt, pom-poms & 2 game tickets included)
•Additional tickets available
To register & for more details call
813.301.6683
2011 SPRING LIGHTNING GIRLS JUNIOR CLINIC
Please fill out one sheet per participant. All information is required.
Participant Name :____________________________________________________________________________________________
Birth Date :______________________________________________ Age :________________________________________________
Parent Name(s) :______________________________________________________________________________________________
Email :_______________________________________________________________________________________________________
Address :_____________________________________________________________________________________________________
City :_______________________________________________________________ State :___________ Zip :____________________
Dance Ability (circle one) :
Beginning
Intermediate
Advanced
PARTICIPATING PACKAGES :
Terrace Package $50 includes 2 terrace level tickets (one ticket is for the participant), a t-shirt, set of poms and autographed card.
Plaza Package $130 includes 2 Plaza level tickets (one ticket is for the participant), a t-shirt, set of poms and autographed card.
PARTICIPANT SHIRT SIZE :
YS
YM
YL
AS
AM
AL
+_ ________________ : Additional Terrace tickets ($25 each)
+_ ________________ : Additional Plaza tickets ($75 each)
+_ ________________ : Parking pass for game day ($12 each)
+_ ________________ : DVD of perfomance ($10 each)
+_ ________________ : Total to be paid
PAYMENT TYPE : Check # VISA
AMX
MC
Checks should be made out to St. Pete Times Forum and can be mailed with form or brought to the Metro PCS Client
Services Lounge.
Credit Card # :___________________________________________________________________________ Exp :________________
Signature of card holder :_ ____________________________________________________________________________________
I hereby release the Tampa Bay Lightning, the clinic staff, and any sponsors or individuals associated with this event
from responsibility for any injuries or damages of any kind, which may incur as a result of my child’s participation in
this event. I hereby certify that she is in good physical condition and is able to participate in this event. I hereby grant
permission for the free use of her photograph in any broadcast or account of this event.
Signature of parent ______________________________________________________________ Date ________________________
I heard about the Spring 2011 Lightning Girls Junior Clinic from (circle one):
Website
Friend/Relative
TBL Employee
At A Game
Participated Last Year
Other________________________________________________________________________________________________________
TO REGISTER : Fill out this form completely and mail, fax or deliver by February 1, 2011:
Mail: Lightning Girls • 401 Channelside Drive • Tampa, FL 33602
Fax: 813.301.1482
Deliver: Metro PCS Client Services Lounge
After registration is received, parents will be contacted with details for the clinic. All participants must be 6-12 years
of age by the date of the first clinic. Make checks payable to St. Pete Times Forum. For more information contact
Alison Goodman 813.301.6683 or via email at [email protected]
WAIVER AND RELEASE
I want to participate in activities on the ice skating rink at the St. Pete Times on _ _______________________________ (date).
I fully recognize that certain risks are involved in entering an ice skating rink and I voluntarily assume the risks for myself, my
family, my child, my estate, executor, personal representative, heirs, legatees, devisees, and anyone claiming by or through
me. Such risks may include, but are not limited to, loss of or damage to property or physical injury to me (or my child) up to and
including death.
Furthermore, I agree that if I (or my child) incur any such loss or property or injury, including death, neither I nor my family
members, estate, executor, personal representative, heirs, legatees, devisees nor anyone claiming by or through me will hold
Center Ice L.L.C. d/b/a, the Tampa Bay Lightning, St. Pete Times Forum, OK Hockey, Inc., or any of the respective affiliates,
employees or agents responsible or seek damages from any of these entities in any form, and I hereby waive and I hereby waive
and release any and all claims against such businesses and persons for personal injury, death or property damage arising out of
participation in on-ice activities and while entering or exiting the rink, unless they, or any one, have acted in a grossly negligent
manner or committed an intentional tort. I further understand that none of these businesses or people carry liability insurance or
hospital or medical protection for these purposes.
During the course of the on-ice activities and while entering or exiting the rink, I will conduct myself in a prudent and cautious
manner and, during the time that I am involved in these activities, I will treat the St. Pete Times Forum and all persons and entities
working at or using the St. Pete Times Forum premises in a lawful manner.
I attest to all of the above that has been written, By signing this waiver, I certify that I have read and understand the above
statements and that my signing this waiver is completely voluntary.
PARTICIPANTS
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________
Name___________________________________________________Signature_______________________________________