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2010 IHA Fall Midget

This document contains an ice hockey registration form for the IceForum Hockey Association. It requests information such as name, address, date of birth, hockey experience, and contact information from the player's parent. It also includes a waiver releasing the association from liability for injuries sustained during play. There are three payment options provided: payment in full online, by credit card, or by check.

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racin33
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36 views

2010 IHA Fall Midget

This document contains an ice hockey registration form for the IceForum Hockey Association. It requests information such as name, address, date of birth, hockey experience, and contact information from the player's parent. It also includes a waiver releasing the association from liability for injuries sustained during play. There are three payment options provided: payment in full online, by credit card, or by check.

Uploaded by

racin33
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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IceForum Hockey Association

Check One: ___ Duluth ___Town Center U.S. Citizen ___ Y ___ N
Check One: ___ Mite (2002 & younger) ___ Bantam (97/96) Season
__________________________
___ Squirt (01 & 00) ___ Midget (94/95) (Fall or Spring /Year)
___ Pee Wee (99 & 98) ___ Midget (93/92) USAH Registration
#__________________

Parents Name: _______________________________________________ (Please Print)


Players Name: _______________________________________________ Date of Birth: ___/___/_____
Address: _______________________________________City: ________________Zip Code: ________
Parents Home Phone: ______________________ Parents Cell Phone: __________________________
Years as a Player: ______ Circle Positions Played: C W D G Player Shoots: ___ Left ___ Righ
Last Division/League: _________________________________________________________________
Parents Email Address: ________________________________________________________________

WAIVER AND RELEASE FORM


In consideration for being allowed to participate in any way in IceForum Hockey Association leagues, practices,
stick time, related events and/or activities, the undersigned agree to the following:
1. Prior to participation, he/she will immediately inspect the facilities and equipment to be used, and if anything is believed
to be unsafe, he/she will immediately advise their coach or supervisor and refuse to participate.
2. Acknowledge and fully understand that each participant will be engaged in activities that involve risk or serious injury,
including permanent disability and even death, as well as severe social and economic losses which might result from
their own actions, inactions, or negligence of others, the rules of play or the condition of the premises and/or any equipment
used. Further, there may be other risks unknown to IceForum and participants not reasonably foreseen at this time.
3. Assume all the foregoing risks and accept personal responsibility for the damages following such injury or permanent
disability or death.
4. Release, waiver and discharge not to pursue legal action against IceForum Inc., its subsidiaries, agents, administrators,
directors coaches, employees, volunteers, independent contractors of the organization, affiliated clubs, their respective
administrators, other players and participants, sponsors, officials, advertisers, sponsoring agencies and owners or lessors the
premises used to conduct events, all of which are hereinafter referred to as “releasees” from any and all liability to the
undersigned or his or her next of kin for any and all claims, losses, damage on account of injury (including death) or damage
to property, caused or alleged to be caused in whole or in part by the negligence of the “releasees” or otherwise.
5. I further understand and agree that if my child is suspended by action of the disciplinary committee, I will not receive any
refund on my IceForum Hockey Association fees during such suspension.
6. I fully understand that if any monies are owed from previous seasons, that my child will not be allowed to participate until
such monies are paid in full.
7. I agree to the league fees and payment policies published for the current season.
8. All fees are non-refundable.
9. Players unable to complete the playing season due to injury or illness will, with a doctor’s waiver, be issued a prorated
credit for next season’s league play.

I have read the above waiver and release and understand that I give up substantial rights by signing below. I am signing the
above release
voluntarily.

X ___________________________________ X _________________________________ ____________


(PRINT parent or legal guardian’s name) (SIGNATURE of parent or legal guardian)
(Date)

Payment Options:

____ Option 1: Payment in Full at WWW.IceForum.com $525.00

____ Option 2: Payment in Full with credit card

________________________________________ _____________
(Credit Card Number) (Exp Date)

________________________ ____________________________________ _____________


(Card Holder Name) (Card Holder Signature) (Date)
(Parent authorizes the IceForum to charge their credit card)
____ Option 3: Payment in Full by Check Attached $525.00 Ck #__________

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