JCC Chai Sports 2017-2018 HockeyRegistration

REGISTRANT'S NAME & ADDRESS
• First Name:
• Last Name:
• Address:
•City:
•Postal Code:
REGISTRANT'S PHONE AND EMAIL
• Home Phone:
• Email Address:
REGISTRANT'S PERSONAL INFORMATION
• Date of Birth:
PLAYER INFORMATION
•Please choose program by Division Name and Birth Years:
Tyke (2011-2012) Novice (2009-2010) Atom (2007-2008) Peewee (2005-2006) Minor Bantam (2004)
OTHER INFORMATION
• Do you have any existing medical conditions:
PAYMENT INFORMATION
Please note that we cannot accept registration without full payment and there are no refunds after August 1st.
  • Early Bird for all divisions will run from April 7th-19th
  • Individual Cost forTyke & Bantam is $440early bird, then $490regular price.
  • Individual Cost for Novice-Peeweeis $525early bird and$575regular price.
Please note that $35 MUST be added to all prices above. This is a mandatory Hockey Canada participant and insurance fee.
Individual Waiver
I, the applicant, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, hereby forever release, discharge and to hold harmless JCC Chai Sports, Chai Life Sports Inc. and Prosserman JCC, its teams, members, representatives and agents of the foresaid organization for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in sports leagues or activities and not withstanding that the same may have been contributed to or occasioned by the negligence of JCC Chai Sports and its membership representatives or agents.
I ALLOW JCC Chai Sports and or its representatives to use, reproduce, publish, transmit, distribute, broadcast and display any photograph and/or video and/or audio recording that contains my image and/or voice along with my name in any JCC Chai Sports and Prosserman JCC publication, multimedia production, video, CD-ROM, DVD, display, advertisement and/or on the website or other social media web sites without further notice or my approval of finished photographs and/or video and/or audio recordings.
I understand that it is JCC Chai Sports policy not to offer any refunds unless otherwise specified in the registration confirmation or if a program ceases to operate. Sports leagues and programs are very expensive to operate as each registration goes towards apparel, equipment, permits, administration, coaching and insurance costs. Children that register and unable to participate due to illness or injury prior to the start of the season may be given a credit for the following season if approved by the Board of Directors. All requests must be submitted in writing to the organization prior to the start of the first game or session.
If under the age of 18, your parent or guardian must sign for you:
Name:______Signature:______Date:______