Clone of PYHA 2026 Adult Spring Rec registration form

2026 Adult Advanced Fall Rec Season Registration

Player Information

Player Name

First NameLast Name

Age

Guardian / Parents Names

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Contact Number

Area CodePhone Number

E-mail

Select your position

Level of experience

	1	2	3	4	5

1 is Beginner, 5 is Advanced

All players will need acquire an RHA (Roller Hockey Alliance) membership
- Need to get RHA Membership?: GO HERE

- When registering with RHA, the membership form will ask you for your home rink. Your home rink will be Pioneer Park.

Important Notes

· Registration for all players deadline is Friday, September 11th, 2026

· Team draft dates: Saturday, September 12th, 2026 through Monday the 14th

Games will be played at the Pioneer Park rink venue

Adult Rec Inline Hockey House Rules:
https://drive.google.com/file/d/1XmPxi2Kfo3C2tPGW6dfjlBzKHIudtmgI/view?usp=drive_link

· The league organizers conduct a draft, whereupon each team will have a captain who ultimately selects their team players.

· Fee: $80.00 per participant. Goalies no cost

· Season begins Wednesday, September 16th, 2026

Are you interested in being a team captain?

Emergency Contact Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Release of Liability

I hereby consent to my participation in the PYHA Hockey League and acknowledge the potential risk of competitive team play and agree to assume the risks involved. By checking the box below, I indicate that I have read the PYHA Rules and Regulations on-line and agree to be bound by them. By checking the box below, I for myself, and on behalf of my heirs, assigns, and next of kin, HEREBY RELEASE AND HOLD HARMLESS - Prescott Yavapai Hockey Assocation (PYHA), the City of Prescott Valley, Yavapai County, their officers, officials, agents and/or employees, Yavapai Inline Hockey Association at Wheelhouse (YIHAAW), their board members and any and all sponsors - WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE.

I have read and agree to the above conditions & have acquired an RHA membership

Adult participant signature

Child's Parent/Guardian Signature

Jesse will be taking payments for the 2026 Adult rec league Fall season from registered adult participants when they arrive at the Pioneer Park facility.