SUMMER 2012 APPLICATION FORM

Player Name: ________________________________________________  Date of Birth _______________
 
Address: ________________________________________________________________________________
 
City _______________________________________________  Postal Code _________________________

Home Phone: _________________________________ Bus / Cell: ________________________________  
 
E-mail:__________________________________________________________________________________
                               (for standings/newsletters/schedule change notices etc)
 
 
Health Card #____________________________________________________________________________
 
Any known Allergy/Medical conditions (specify)_________________________________________________
 
Please circle appropriate choice: GOALTENDER    DEFENCE     FORWARD    

Calibre of hockey last played: HOUSE LEAGUE     SELECT   AE    "A"    "AA"    (NO "AAA" players)

I would like to play with:_______________________________________________________________________
                                                                 (Name up to two players)
                                        
Parents: Are you willing to coach or sponsor ?  (please circle)  COACH       SPONSOR

PLAYER HEALTH CERTIFICATION: Upon signing this application, the parent/guardian certifies that the player is in good normal health, is properly equipped (full hockey equipment mandatory) and has no abnormal handicaps.
PLAYER/PARENT/GUARDIAN CONDUCT: Niagara Falls Summer Minor Hockey League and/or Halton Mens Hockey Inc.and/or DJ Management operates on Municipal property with the permission of the City of Niagara Falls. 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.
PARTICIPANT WAIVER AND INFORMED CONSENT: To whom it may concern: I, the undersigned, authorize The Niagara Falls Summer Minor Hockey League and/or Halton Mens Hockey Inc. and/or DJ Management and/or City of Niagara Falls 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 my child. 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 informed consent to allow my child to participate knowing the risks involved. And I hereby indemnify and save harmless the The Niagara Falls Summer Minor Hockey League and/or Halton Mens Hockey Inc. and/or DJ Management and/or City of Niagara Falls 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

Print Child's name here ______________________________________

while participating in any activity or facility operated by The Niagara Falls Summer Minor Hockey League and/or Halton Mens Hockey Inc. and/or DJ Management and/or City of Niagara Falls.   My signature below indicates that I am a Parent/Legal Guardian/Adult participant having the legal right to assume the conditions above on behalf of the player named above. My signature below also indicates that I have thoroughly read and agree to all of the terms above.

Player Signature ___________________________________________________
 
Parent Signature ___________________________________________________
 
Parents' First Names_________________________________& ________________________________

Dated this ______________ day of _______________________, 2012