2025 USARS INLINE HOCKEY TEAM USA FORMS

2025 USARS INLINE HOCKEY TEAM USA FORMS
Team Selected for*

SR WOMENSR MENJR WOMENJR MEN
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
DOB*

MonthDayYear
Date
Birthplace*
Passport #*
Passport Issue Date and Expiration Date*
Passport Issuing Country*
Physical Description: Height-Weight-Hair Color*
Next of Kin Information- Relationship-Name-Address-Email-Phone*
Medical Operations- type and date*
Medications*
Allergies*
Skin Disorders*
Current or Past Medical Conditions*
Current or past Injuries*
I acknowledge that I have read and agree to the above Team Member agreement*

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Parent or Guardian signature if athlete is under 18 years of age

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I acknowledge that I have read and agree to the above Assumption of Risk, Release and Indemnification form*

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Parent or Guardian signature if athlete is under 18 years of age

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ACKNOWLEDGEMENT TO USE PERSONAL INFORMATION ON BEHALF OF ATHLETE AND ACCEPTANCE OF PRIVACY POLICY

I hereby acknowledge that from time to time, USA Roller Sports can use my personal information in arranging my participation in an international competition, such as team entry, and other areas related to World Skate events only. I hereby authorize this use as needed and accept the privacy policy of World Skate, found at http://www.worldskate.org/privacy.html
I acknowledge that I have read and agree to the above Privacy Policy*

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Parent or Guardian signature if athlete is under 18 years of age

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I acknowledge that I have read and agree to the above Code of Conduct*

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Parent or Guardian signature if athlete is under 18 years of age

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I acknowledge that I have read and agree to the above Anti Doping Agreement form*

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Parent or Guardian signature if athlete is under 18 years of age

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I acknowledge that I have read and agree to the above Team USA Financial Agreement*

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Parent or Guardian signature if athlete is under 18 years of age

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