
Please fill out completely and return this information sheet along with the following:
Full or 1st
payment towards dues by FIRST GAME (Checks Payable to “
PLEASE PRINT CLEARLY
NAME:
__________________________________________________________BIRTH
DATE____________________________________
ADDRESS:__________________________________________CITY________________________________ST________ZIP__________
HOME PHONE :__________________________________________
WORKPHONE: _________________________________________
CELL PHONE:
___________________________________________ E-MAIL:
_______________________________________________
LEVEL________________________________TEAM NAME __________________________________________________________
˙ VISA ˙ M/C ˙ AMEX
˙ PLAN II INSTALLMENT PLAN - $600.00
CC #
_______________________________________ To be paid
in 2 payments as follow:
Down payment: by Registration $350.00
Exp Date___________________
2nd payment:week of Dec. 8 ,’08 + $250.00 Total=$600.00
Amount
$____________________________
˙ GOALIE SPECIAL PRICE
- $290.00
Signature________________________________
REFUNDS: There will be no refunds *ALL PLAYERS MUST MAKE A FULL
OR 1ST PAYMENT
DUES COVER PRIOR TO FIRST GAME OR THEY
WILL NOT BE
l 20
Regular Season Games ALLOWED ON THE ICE. NO EXCEPTIONS!!!
l
Playoffs Games, if team is eligible
l Awards for
championship team members
INJURIES: All
injuries must be reported to the scorekeeper or League office within 24 hours. There is a 2
game injury/grace period. The injured
player will
remain on the team roster for two subsequent games. After this "grace" period, it is
the responsibility of the player to notify the office in writing if he/she will
continue playing or be leaving team due to the injury.
PLEASE READ CAREFULLY
WAIVER AND RELEASE OF LIABILITY VALLEY ICE CENTER; ADULT HOCKEY LEAGUE, INC. (HEREBY REFERRED TO AS
"LEAGUE")
In consideration of being
allowed to participate in any way in sports programs and other sponsored
activities at or by LEAGUE, the
undersigned acknowledges and agrees as follows:
1.
I ACKNOWLEDGE AND
FULLY UNDERSTAND THAT I WILL BE ENGAGING IN ACTIVITIES THAT INVOLVE RISK OF
SERIOUS INJURY,
INCLUDING PERMANENT DISABILITY
AND DEATH, AND SEVERE SOCIAL AND ECONOMIC LOSSES WHICH MIGHT RESULT NOT ONLY
FROM MY OWN ACTIONS, INACTIONS, OR NEGLIGENCE, BUT ALSO FROM THE ACTION,
INACTION OR NEGLIGENCE OF OTHERS, THE RULES OF PLAY, OR THE CONDITION OF THE
PREMISES OR COMPETITION AREA OR ANY EQUIPMENT USED, FURTHER, THAT THERE MAY BE
OTHER RISKS NOT KNOWN TO ME OR NOT REASONABLY FORESEEABLE AT THIS TIME.
2.I AGREE THAT PRIOR TO PARTICIPATING IN ANY ACTIVITY
SPONSORED BY LEAGUE, I WILL INSPECT
THE COMPETITION AREA AND ALL EQUIPMENT TO BE USED, AND IF, THROUGH MY
INSPECTION, I DETERMINE THAT ANYTHING RELATED TO THAT ACTIVITY I S UNSAFE, I
WILL IMMEDIATELY ADVISE MY COACH OR AN OFFICIAL OF LEAGUE OF THIS UNSAFE CONDITION AND WILL NOT PARTICIPATE UNTIL THE
CONDITION IS CORRECTED.
3.I ASSUME ALL FOREGOING RISKS AND ACCEPT PERSONAL
RESPONSIBILITY FOR THE DAMAGES FOLLOWING SUCH INJURY, PERMANENT DISABILITY, OR
DEATH.
4.I RELEASE,
WAIVE, DISCHARGE, AND COVENANT NOT TO SUE LEAGUE, IT'S AFFILIATED CLUBS, THEIR RESPECTIVE
ADMINISTRATORS, DIRECTORS,
AGENTS, ATTORNEYS, COACHES, AND OTHER EMPLOYEES OF THE ORGANIZATION, OTHER
PARTICIPANTS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND, IF APPLICABLE,
OWNERS AND LESSORS OF PREMISES USED TO CONDUCT THE EVENT, ALL OF WHICH ARE
HEREINAFTER REFERRED TO AS "RELEASEES", FROM DEMANDS, LOSSES, OR
DAMAGES 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. Any on or off-ice abuse from league
players and or players booking events at Valley Ice Center, whether verbal or
written (such as a phone call, letter, and/or e-mail) of Valley Ice Center
staff including employees, league administrators, and or management can receive
a suspension from league and/or rink activities/events or even a ban from the rink
at the discretion of the General Manager.
5. I HAVE
READ THE ABOVE WAIVER AND RELEASE AND UNDERSTAND THAT I HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. I ALSO AGREE TO ABIDE BY ALL RULES OF THE
ICEOPLEX ADULT HOCKEY LEAGUE AS OUTLINED IN THE EFFECTIVE RULE BOOK.
Date:________________________ Players
Signature_____________________________________