Form

2018 Spring Youth Recreational Hockey League

Registration Form
Here are some key dates for our Spring Rec season:Spring Rec 2018 Opening Day- March 19th 5-7 pm (Registration will open in January)Spring Rec 2018 Equipment Check Out- March 7th 5-7 pm, Spring Rec end of season Tournament- May 19thSpring Rec Equipment return- May 23rd
REGISTRANT INFORMATION
Full Name *

First Name Last Name
Birth Date *

Month Day Year

Address *

Phone Number *
E-mail *
Level of Experience *
Jersey Size *
Age Division *
Does your player need to rent gear? *

Yes No
Indicate rental gear if needed
AAU Membership Number
Please upload a copy of your player's AAU info *

Browse Files
This can be a variety of file types, which include .pdf or .jpg and many other. If you have any questions regarding AAU, please email us at info@prescottyouthhockey or pyhaprez@gmail.com Cancel of
GUARDIAN INFORMATION
Parent/Guardian *

First Name Last Name
Phone Number of Parent or Guardian *

- Area Code Phone Number
Additional Parent/Guardian

First Name Last Name
Additional Parent/Guardian Email
example@example.com
VOLUNTEER INFORMATION
Are you interested in coaching or volunteering? *

Yes No
If coaching or volunteering, please indicate your area of interest
WE ARE INTERESTED IN YOUR INTEREST
How did you hear about the PYHA? *
Is your player interested in tournament travel hockey? *

Yes No
Find out more about Prescott Storm travel hockey.
comments

Youth Registration Payment

15u Division Skater Fee $ 85.00

8u/12u Skater Fee $ 85.00

8u/12u additional Child Skater Fee $ 65.00

Goalie Fee for all divisions (No discount for additional child) $ 25.00

Enter coupon

Total $ 0.00

LIABILITY WAIVER

Please read carefully before submitting form
I hereby consent and agree to my child's participation in the PYHA Hockey league. I acknowledge the potential risk of competitive team play and agree to assume the risks involved, being aware of my child's health and physical condition, and having knowledge that my participation in any recreational inline hockey program may be injurious to my childs health, am voluntarily participating in the Prescott Youth Hockey Association recreation hockey league.

Having such knowledge, I hereby release and hold harmless, the PYHA, the city of Prescott, Yavapai County, their officers, agents and/or employees and successors from liability for accidental injury or illness, which my child may incur as a result of participating in the Prescott Youth Hockey Association youth recreational league. I hereby assume all risks connected therewith and consent to participate in said program.

I agree to disclose any physical limitations, disabilities, ailments, or impairments that may affect child's my ability to participate in said inline hockey program.
Please tick box in agreement to the above liability waiver *

I Agree
Parent or Guardian signature for consent

Clear
Should be Empty:

Find out more about Prescott Storm travel hockey.