logo blue PLAYER REGISTRATION –LEVEL 6 ADULT LEAGUE – Summer 2010

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 “Valley Ice Center.”) 
  • SIGNED waiver form.
  • All Players MUST register with USA Hockey on-line…www.usahockey.com…cost is $32… 
  • USA Hockey Membership MUST BE RENEWED EVERY SEPTEMBER.

                                  

                                                                     PLEASE PRINT CLEARLY   

 

NAME:_________________________________________________________BIRTHDATE__________________

 

ADDRESS:________________________________CITY____________________________ST_____ZIP_______

 

HOME PHONE :________________________CELLPHONE: _________________________________________

 

E-MAIL:_______________________________________________

 

 

                                                                                                                

˙ VISA                  ˙ M/C                    ˙ AMEX                                                   

 

CC # _______________________________________           Exp Date______________                                                                       

 

Amount $____________________                                                                              

 

Signature________________________________                                                                                                                                                                                                                                                                            

(PLEASE CIRCLE ONE OF THE FOLLOWING PAYMENT OPTIONS)

 

PAYMENT 1                       PAYMENT 2                                       TEAM PAYMENT 1                         TEAM PAYMENT 2

- $475 due APR 15              - $275 due APR 15                              - $5100 due APR 15                           - $2620 due APR 15          

$475 total due APR 15        - $200 due JUN 17                            $5100 total due APR 15                    - $2620 due JUN 17

                                                $275 total due APR 15                                                                                      $2620 total due APR 15

                                                                                                                                                                               

LEVEL 6 ADULT LEAGUE COSTS COVER:

  • 16 Regular Season Games
  • Playoff Game(s)
  • Awards       

 

REFUNDS: There will be no refunds!               

*ALL PLAYERS MUST MAKE A PAYMENT AT THE START OF THE FIRST GAME OR THEY WILL NOT BE ALLOWED ON THE ICE. NO EXCEPTIONS…

 

                                                     PLEASE READ CAREFULLY

WAIVER AND RELEASE OF LIABILITY VALLEY ICE CENTER/ ADULT HOCKEY LEAGUE (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.

5.                     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.

6.                                       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 AS OUTLINED IN THE EFFECTIVE RULE BOOK.

 

             

            Date:________________________       Player signature_____________________________________