Youth Individual Ball Hockey Registration 2011

Central City Arena Youth BALL HOCKEY Registration

POSITION*

PlayerGoalie

SKILL LEVEL*

BeginnerAverageGoodExcellent

Have you played in an organized Ball Hockey, Ice Hockey, or Roller Hockey league?*

How did you hear about our league?*

FULL NAME*

First NameLast Name

ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

PHONE NUMBER*

Area CodePhone Number

EMAIL ADDRESS*

DATE OF BIRTH*

MonthDayYear

PARENT / GUARDIAN

First NameLast Name

PHONE

Area CodePhone Number

VOLUNTEER ASSISTANTS & COACHES

No, I am not able to coachYes, I would like to be an assistant / coach

Coach's Name

First NameLast Name

Phone Number

Area CodePhone Number

PLAYERS CAN REQUEST TO PLAY WITH 1 FRIEND. (Enter name here)

LEAGUE FEES*

Ball Hockey Registration- PLAYER $120 + GST = $126.00$126.00CAD

Ball Hockey Registration- GOALIE $50 + GST = $52.50$52.50CAD

AGREEMENT, RELEASE AND WAIVER OF LIABILITY

By submitting this document, you will waive certain legal rights, including the right to sue. In consideration of being permitted to participate in or assisting others inparticipation events, and related events and activities at Central City Arena (a facility owned and operated by Willow Industries Ltd.), on behalf of myself, or a minor child or ward, heir, next of kin, personal representative, successor or assign;

(1) (a ) To the best of my knowledge, the PARTICIPANT (listed above) is in Good Physical Condition and has no disease or injury that would be aggravated byparticipating in activities related to Central City Arena;

(b) Participating or assisting others in participating in events at Central City Arena involve RISK OF INJURY TO THE PARTICIPANT, INCLUDING DEATH, LOSS OR DAMAGE TO THE PARTICIPANT’S PROPERTY, or other consequences, which might result not only from the PARTICIPANT’S actions, in actions or negligence but also the actions, in actions or negligence of others, the rules of play, or the conditions of the premises or of any equipment used;

(c ) There may be OTHER RISKS not known or not reasonably foreseeable; and Understanding All of the Above,

(2) I ASSUME ALL OF THE ABOVE RISKS ON BEHALF OF MYSELF AND THE PARTICIPANT AND RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS,INDEMNIFY AND COVENANT NOT TO SUE:

(a ) Central City Arena, Willow Industries Ltd., or any of its owners, its agencies, its Board of Directors, its employees, agents, volunteers, coaches, trainers, or officials affiliated with their programs;

(b ) Any affiliated subsidiary, successor, organization, or related companies or businesses, other participants, participating or sponsoring municipalities, governmental agencies, international organizations, agencies, sponsors, or advertisers, the respective administrators, officers, directors, agents, representatives, employees, or volunteers of such entities or organizations;

(c ) Owners, lessors and lessees of premises used to conduct the activities FROM ANY AND ALL LIABILITY FOR INJURY, INCLUDING DEATH, LOSS OR DAMAGE TO PERSON OR PROPERTY, OR ANY OTHER CONSEQUENCE in connection with entry in or arising our of participation in, performance or lack of performance in, including travel en route to and from Central City Arena.

(3) I AGREE THAT:

(a ) Prior to participating, I as a parent or guardian, will INSPECT the facilities and equipment to be used, and if I believe same to be unsafe, I will immediately REPORT such condition(s) to the athletic coach, supervisor or official connected with Central City Arena or same and either DECLINE PARTICIPATION or ASSUME THE RISK of participation.

(b) I will ALLOW my PHOTOGRAPH, PICTURE or LIKENESS and/or VOICE to APPEAR in any official documentary, promotional (including and all advertisements), television, radio or film coverage of the event(s), WITHOUT COMPENSATION.

(4) I CONSENT TO:

(a ) ALL EMERGENCY MEDICAL TREATMENT as may be deemed appropriate under existing circumstances by medical personnel or personnel associatedwith the events at Central City Arena. I HAVE READ THIS FORM IN ITS ENTIRETY AND HAVE PROVIDED TRUTHFUL INFORMATION.

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