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the form, complete and mail to address below NOTE: A team registration is not considered complete until 11 (12 in the case of Atom
teams) individual 3 on 3 registration forms have been completed/submitted separately along with either 11 (12 Atom) individual
player cheques or one team cheque. Partial team entries are not accepted!
ST. CATHARINES REP 3 on 3 HOCKEY
Summer 2012 Team
Application Form (for AA-AAA
players only)
Team Name: ____________________________________________________________________________________
Team Colours: __________________________________
Note: Teams are required to provide their own sweaters, colours
pending league approval. Consult league before purchasing sweaters.
Division: Please circle: Atom (4 on 4), PeeWee, Bantam,
Midget
Team Rep Name________________________________________
Team Rep.Address:_____________________________________________________________
City________________Postal
Code__________
Home Phone:___________________________ Bus: ___________________________
E-mail:_________________________________________________________
TEAM
REP HEALTH CERTIFICATION: Upon signing this application, the team rep certifies that all players are in good normal
health, are properly equipped (full hockey equipment mandatory) and have no abnormal handicaps.
PLAYER/PARENT/GUARDIAN
CONDUCT: The St. Catharines Summer Minor Hockey League and/or Halton Mens Hockey Inc. and/or DJ Management
Ltd. operates on Municipal property with the permission of the City of St. Catharines. To this end, players, parents/guardians
and participants will respect the facilities and grounds and will abide by the rules set forth by the facility and staff.
TEAM REP HEALTH CERTIFICATION: Upon signing this application, the team rep certifies that all players are
in good normal health, are properly equipped (full hockey equipment mandatory) and have no abnormal handicaps.
PLAYER/PARENT/GUARDIAN
CONDUCT: The St. Catharines Summer Minor Hockey League and/or Halton Mens Hockey Inc. and/or DJ Management
Ltd. operates on Municipal property with the permission of the City of St. Catharines. To this end, players, parents/guardians
and participants will respect the facilities and grounds and will abide by the rules set forth by the facility and staff.
TEAM
REP WAIVER AND INFORMED CONSENT: To whom it may concern: I, the undersigned, authorize The St. Catharines Summer
Minor Hockey League and/or Halton Mens Hockey Inc. and/or City of St. Catharines and/or DJ Management and/or anyone acting
on their behalf to acquire necessary medical aid that may be required as a result of any accident or injury which may be sustained
by members of this team. I have been warned and informed via this document that insurance coverage is not provided and there
are serious physical risks associated with hockey, including, but not limited to falls and/or collisions with stationary objects,
other players, skates pucks and sticks. My signature below indicates my confirmation that I have explained these risks to
the parents of all team member. And I hereby indemnify and save harmless the The St. Catharines Summer Minor
Hockey League and/or Halton Mens Hockey Inc. and/or City of St. Catharines and/or DJ Management and/or anyone acting
on their behalf from any and all actions, claims and demands for damages, loss or injury however arising which here to after
may have been sustained by any member of the team while participating in any activity or facility operated by The St.
Catharines Summer Minor Hockey League and/or Halton Mens Hockey Inc. and/or City of St. Catharines and/or DJ Management.
My signature below indicates that I am the team rep having the legal right to assume the conditions above on behalf of the
team players named on the roster sheet. My signature below also indicates that I have thoroughly read and agree to all of
the terms above.
TEAM REP SIGNATURE _______________________________
DATED THIS
________DAY OF ________, 2012
TEAM ENTRY FEES: $3,113.00 + HST = $3,517.00 (based on 11 players)
ATOM TEAMS: $3,396.00 + HST = $3,837.00 (based on 12 players)
MAIL TO: ST. CATHARINES 3 ON 3 SUMMER HOCKEY, 66 Carmine St., St. Catharines, ON L2S 3M2
