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3V3 registration form 2017

By RP, 02/22/17, 5:30PM CST

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GET registered NOW for Spring hockey 2017

                                                               


 

Mite through HS Individual registration Form Spring 2017

  

You must register at the level you will play in the 2017-18 season

I am registering for Spring Mite____ Squirt____ Pee Wee_____ Bantam______ HS_______

 

 

Player Name__________________________________      Date of Birth___________________

Level of play 2016-17 season_____________You must register at the level you will play in the 2017-18 season

 

Home Address_______________________________________ City__________________ Zip_______________

 

Email address________________________________________________________

 

Parent Name(s)_______________________________________________________

 

Contact Phone number(s)__________________________________________________________________

 

 

I have read the 3V3 rules and will abide by them. YES__NO__

 

I understand that there are certain dangers inherent in playing hockey and/or ice skating, which include, but are not limited to injuries or death from contact with other players/skaters, sideboards, goal standards, the ice, the puck, and equipment.  In consideration of allowing my child to participate in the League and use the facilities of the Ponds of Brookfield LLC, I, individually and for all others who may make a claim based on an injury to me, accept and assume the risk of all injuries and property damage and fully release, discharge, hold harmless and agree to indemnify Impact Hockey and The Ponds of Brookfield  and all of its agents from any liability, claims, loss or damage to me and for any injury and damage to property which may occur while I am at the Ponds of Brookfield.  I understand that the purpose and intent of this waiver is to prevent me, and others who may claim through me, from recovering any money from Impact Hockey and The Ponds of Brookfield LLC, and its agents, for any injuries and property damage I suffer while playing hockey, skating, or participating in activities at the Ponds of Brookfield. Consent: I the undersigned parent or guardian/participant do hereby grant authority to the staff at Impact Hockey or The Ponds of Brookfield to render a judgment concerning medical assistance or hospital care in the event of an accident or illness during my absence. I do hereby authorize Impact Hockey and The Ponds of Brookfield and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in its promotional materials or team films.

 

________________________________________________                                Date______________________________

Parent/Guardian Signature

 

 

Amount Included with Registration form $_________ (Individual fees $150 All levels) checks made out to:  The Ponds of Brookfield, Credit card payments can be made at the rink) ANY QUESTIONS PLEASE Contact Rob @ 262-786-7663 rob@thepondsofbrookfield.com OR Bud Simon   bud@impacthockeycamps.com