Las Vegas Ice Center > Forms > 2020 Mites Tournament Program Registration

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Parent Guardian 1

First Name

Last Name

Street

City

State

Zip

Contact Phone

Email

Parent Guardian 2

First Name

Last Name

Contact Phone

Email

Please contact us at (702)320-7777 ext 115 to complete registration.

Skate Package

Session Times

Skill Level

Emergency Contact

Emergency Contact Information
First Name:		Last Name:
Phone:		Email:
Street:		City:
State:		Zip:
			Same as Parent/Guardian 1

Physicians' Information
Physician’s Name:		Physician’s Phone:
Preferred Hospital of Choice:

Camp Sign-up Options

SKATER INFORMATION

Number of Skaters

Purchaser Info

First Name

Last Name

Email

Contact Phone

Card Info

Credit Card #

Month

Year

CCV

Consent To Play

I Agree to LVIC Liability Waiver and Release

Make Purchase Cancel

Contact

Phone : (702) 320-7777
WebSite : www.lasvegasice.com
E-mail :[email protected]
Employment

Address

Las Vegas Ice Center

9295 W. Flamingo Road Ste. 130

Las Vegas, NV 89147

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