/ Vegreville and District Minor Hockey Association
Registration Form
2013 – 2014 Season

Checklist

Fees

Completed registration forms must be accompanied with payment to be accepted by VDMHA

Level / BIRTH YEAR / FEE
Received Prior to / onAug 26 / LATE REG. FEE
Received After Aug 26 / TOTAL FEE
Initiation / 2007-2009 / $150 / $150
Novice / 2005-2006 / $350 / $450
Atom / 2003-2004 / $400 / $500
Pee Wee / 2001-2002 / $450 / $550
Bantam / 1999-2000 / $500 / $600
Midget / 1996-1998 / $550 / $650
Midget AA / 1996-1998 / $550 / $650
Hockey School(optional) :
Family Discount: Families registering 3 or more players prior to August 26, 2012 will be eligible for a $100.00 discount / -$100.00
Attached $500/family participation commitment bond
Total Fees Owing
*** Cheques can be made payable to VDMHA ***

***Every Registration Form must be submitted with full payment***

PAYMENT OPTIONS:

Payment can be made in full at time of registration OR post dated cheques as follows:

1st installment dated August 26 2013 (1/2 of registration fee)

2nd installment dated October 15, 2013 (¼ of registration fee)

3rd installment dated November 15, 2013 (¼ of registration fee)

For further information, please contact Catherine at 780 603 0360 or Shauna at 780 632 1188

FOIP/Media Release

Consent to disclose athlete’s personal information to our website in accordance to the Freedom of Information and Protection of Privacy Regulation A.R. 200/95, Section 6, as amended, Section 40(1)(d).

By signing this document, you consent/not consent to disclosure of personal information about your child for posting to the Vegreville and District Minor Hockey website, , which can be viewed by anyone who accesses this website throughout the world.

Consent only applies to the items below that I/we have initialed next to:

Athletes name and team name

I hereby give permission for the association to use this information for my child for all purposes as specified and initialized above. Consent is withheld on all items not bearing my/our initial(s).

I/we understand that this consent is valid for one year and may be withdrawn by me/us at any time, upon written notice. In the event that consent is withdrawn, I/we understand that the information about my/our child will be removed from the website.

Respect in Sport

Hockey Alberta has implemented the Respect in Sport Parent and Activity Leader programs for all parents and team officials in Alberta for the 2012/13 hockey season. By December 1, 2012 and beyond, completion of the Respect in Sport “Parent Program” will be required by each family of every player as a condition of the player’s eligibility to participate on a sanctioned hockey team

The cost to take Respect in Sport is $12.00/family for the Parent Program and $30.00/team official for the Activity Leader Program.

Both programs are available immediately and can be accessed at

Player’s Information / Mother’s Information / Father’s Information
Name
Mailing Address / Same or : / Same or :
Legal Land Description / Same or : / Same or :
Town / Same or : / Same or :
Postal Code / Same or : / Same or :
Email Address / Same or : / Same or :
Home Phone / Same or : / Same or :
Cell Phone
Birthday (DD/MM/YYYY)
Hockey Alberta Number / Respect In Sport / Respect In Sport
AHC Number / Level For 2013 - 2014

Did this child play minor hockey last year? (Please check appropriate box)

Level / Position (Atom and higher) / Shoots
Yes with VDMHA
If player is registering in ATOM, submit a copy of player’s birth certificate
Yes with another association
Name of Association: ______
  • Submit parent declaration form
  • Submit a copy of player’s birth certificate
  • Submit a SIGNED RELEASE from the President of the previous hockey association

No, first time player
Submit a copy of player’s birth certificate

Media Release

By signing this document, you consent/donot consent to disclosure of personal information about your child for posting to the Vegreville and District Minor Hockey website, which can be viewed by anyone who accesses this website throughout the world.
Consent only applies to the items below that I/we have initialed next to:
: Athletes name and team name / : individual photographs / : team photographs / : interviews / : awards

I/we, the parent(s)/guardian(s) do hereby certify that the information is correct and approval is given for the applicant to

participate in any and all VDMHA activities during the hockey season.

Signature of Parent or Legal Guardian ______

Name (Please Print) ______

Signature of Witness______

Name (Please Print) ______

Date ______2013

OFFICE USE ONLY
Receipt Issued / Birth Certificate / Signed Release / Full Payment / Total Fees
Respect In Sport / Commitment Bond / Declaration Form / Split Payment
Additional Players Registered / Initiation / Novice / Atom / Pee Wee / Bantam / Midget