BALTIMORE ICEDOGS MINOR HOCKEY ASSOCIATION

P.O.BOX 195, BALTIMORE, ONTARIO K0K 1C0

SUMMER HOCKEY SCHOOL

TO BE DETERMINED - WATCH FOR SIGNS

REGISTRATION DEADLINE: 
CHILD’S SURNAME:  _____________________ FIRST NAME:  _____________________
DATE OF BIRTH (d/m/y) :  _____________________
ADDRESS: _____________________________________________________________________
TOWN OR TOWNSHIP OF:  ______________________  POSTAL CODE:  _____________________
PARENT/GUARDIAN (1) ______________________ PHONE: _____________________
PARENT/GUARDIAN (2) ______________________ PHONE: _____________________
POSITION NORMALLY PLAYED: _____________________ EMAIL ADDRESS:     _____________________

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

SCHOOL PARTICIPATION FEE: $0 X ____ = $_______                                                                                                             

PLEASE MAKE CHEQUES PAYABLE TO BALTIMORE MINOR HOCKEY ASSOCIATION

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Parent / Guardian Information:

In consideration of allowing the above named person to play hockey, I hereby, personally and on behalf of him or her, release the Baltimore Minor Hockey Association, the directors and agents thereof from any and every obligation, liability, claim or demand whatsoever arising out of any injuries or accidents, or the treatment thereof, including, and without limitation, liability in tort, and extending to all damages whenever and wherever arising, including but not limited to, any injuries incurred during the playing of the game, the practices and transportation to and from the arenas or any other Baltimore Minor Hockey function.

I understand and agree that my name and phone number will be listed on my child’s team list and made available to coaches and executive members. I also understand and agree that articles and/or photos of my child may be used in newsletters, bulletin board postings, brochures or on the BMHA website.

I agree that my child will be playing by BMHA Constitution and Playing Rules. Since this is a limited time and specific course, I understand that if my child is deemed disruptive, they will be asked to leave the school without a refund.

PARENT/GUARDIAN SIGNATURE: ______________________________________ DATE: ______________________

PLEASE USE ONE FORM PER CHILD. PHOTOCOPY OR DOWNLOAD ANOTHER COPY FOR YOUR OTHER CHILDREN.