If Address Is New Check __ New Address / E-Mail Address / Date____/____/20___
1) First Name / Last Name / Age
2) Address / City / State / Zip
3) Position __ Center __ R Wing __ L Wing __ Defense __ Goalie / Phone: Home ( ) Alt ( )
4) Please Estimate Your Skill Level __ A __ B __C (Novice)
5) Please Check Here If You Want To Register For The Masters League (35 Years or Older) __
6) Last Year’s Team ______Team Request ______
7) __ New Player __ Returning Player __ New Player, were you referred by anyone and by whom?______
Visa or MC Number, Including Expiration Date: → ______/______/______
How Did You Hear About The League? __ Internet __ Newspaper __ Phone Book __ Friend __ Other ______
Check Box
1) __ / Registration Full Payment $______ Receipt # ______By ______Date ______/______/______/ $ .00
2) __ / Registration Full Payment $______Receipt # ______By ______Date ______/______/______/ $ .00
3) __ / Registration Full Payment $______ Receipt # ______By ______Date ______/______/______/ $ .00
4) __ / Other (Must be approved by league director) Receipt # ______By ______Date ______/______/______/ $ .00
Print Players Print Players
First Name Last Name
READ WARNINGS CAREFULLY AND SIGN BELOW: TEAM ______
Payment of League fees----must be completed before placement on a team, although payment alone does not obligate Hampton Roads IcePlex to place a particular player on any team. Every effort will be made depending on: Date of registration, player ability, experience and previous team affiliations. These are all factors used in evaluating players for teams in the I.H.L. Full refunds will be made to any player who paid their fees but were unable to be placed on a team. Players without a team jersey will not be allowed to play.
PLAYERS MAY NOT SUBSTITUE FRIENDS, FAMILY MEMBERS OR ANYONE FOR GAMES MISSED. WHOEVER VIOLATES THIS RULE WILL BE SUSPENDED AND THE GAME WILL BE AN AUTOMATIC FOREFIT.
Players with high penalty minutes may be expelled from the league for the remainder of the season.
ICE HOCKEY IS A HAZARDOUS SPORT!!!
- HAMPTON ROADS ICE PLEX HAS A MANDATORY FACE MASK RULE. ALL PLAYERS MUST WEAR A FULL FACE MASK, NO HALF SHIELDS.
- NO REFUNDS FOR INJURIES OR ANY REASON AT ALL.
EXPRESS ASSUMPTION OF RISK AND RESPONSIBILITY: I agree to play ice hockey at Hampton Roads IcePlex at my own risk and - understand injuries do occur. I assume all risk and responsibility for ANY INJURIES I may sustain and any damage I may cause at Hampton Roads IcePlex.
- COMPLETE RELEASE FROM LIABILITY: I agree to release Hampton Roads IcePlex, any Hockey League I participate in at Hampton Roads IcePlex and their employees from all claims and liability for injuries I may sustain or any damage that may be caused to my property in connection with my activities at Hampton Roads IcePlex.
- Injuries do occur in the sport of ice hockey that cannot be predicted and all medical costs are the responsibility of each and every player, their parents or legal guardian.
- If you feel there are any safety concerns while playing ice hockey, you agree to remove yourself immediately from participating. Please inform John Smith (Hockey Director) of your concerns. John will issue a free one game credit on your next hockey registration.
- IT IS HIGHLY RECOMMENDED ALL PLAYERS HAVE HEALTH INSURANCE TO COVER INJURIES. HAMPTON ROADS ICEPLEX OR HOCKEY LEAGUE DOES NOT HAVE HEALTH INSURANCE TO COVER ANY HOCKY INJURIES.
- IT IS EVERY PLAYERS RESPONSIBILITY TO PURCHASE THEIR OWN HEALTH INSURANCE FOR ANY HOCKEY INJURIES THAT MAY INCUR, AND IT WOULD BE RECOMMENDED THAT EACH PLAYER HAS YEARLY PHYSICALS TO ENSURE THAT THEY ARE PHYSICALLY FIT TO PLAY HOCKEY.
- I further agree to hold harmless all players in the league that may cause injury while playing ice hockey.
- I have also read and agreed to play ice hockey at Hampton Roads IcePlex in accordance with current and any future league rules. The Hampton Roads IcePlex reserves the right to terminate this registration at any time and charge a $75.00 service fee.
- YOU PLAY ICE HOCKEY AT YOUR OWN RISK-Serious or fatal injuries can occur while playing ice hockey. Heart attacks, death, head injuries, broken bones, back and neck injuries, cuts requiring stitches, and abrasions have all occurred at Hampton Roads IcePlex. If you are hurt, you will have to pay for your own medical expenses, and you will NOT be compensated for any other expenses, losses, or damages you may incur or suffer.
- BE AWARE OF THE ICE SURFACE. While the ice is resurfaced at intervals, all skaters must skate with the understanding that the ice surface develops cracks, ruts, and holes as skating continues. It is impossible to keep the ice surface completely smooth.
- ALCOHOL AND SKATING DO NOT MIX. “I agree to not be under the influence of alcohol or other intoxicants while on the ice.” Even a slight impairment of coordination increases the risk of injury to others as well as to the skater.
RELEASE AGREEMENT
I hereby affirm that I understand the dangers of ice hockey and ice skating, including the risk of death or permanent injury.
I agree and understand that Hampton Roads IcePlex does not serve as guardian of my safety and that in consideration of being allowed to play ice hockey at Hampton Roads IcePlex, I hereby personally assume all risks associated with ice hockey. These risks include the conditions of the ice at Hampton Roads IcePlex, the behavior of other skaters and players, the inexperience of other skaters, and my own inexperience or lack of skill. Since I am willing to assume generally all risks of injury or death associated with ice skating and ice hockey at Hampton Roads IcePlex, I also assume particular risks which may not be apparent to me at the time of the signing of this RELEASE.
I understand that my signature on this agreement stands as proof that I have assumed all risks of injury or death associated with ice skating and ice hockey.
I am satisfied that I am physically fit to play ice hockey and I assume all responsibility for my physical condition and capability to play ice hockey and ice skate.
I have read and understand the Hampton Roads IcePlex rules and IcePlex Hockey League Rules. I agree to abide by these rules as a condition of being allowed to skate and play at Hampton Roads IcePlex.
I agree and understand that I am responsible for the safety and condition of my own equipment. I also agree and understand if I have rented ice skating or hockey equipment from Hampton Roads IcePlex I have done so at my own risk and will examine it thoroughly before using it.
I agree and understand that this release agreement is binding upon my heirs, executors, administrators, assigns and legal representatives; that this agreement releases all owners, directors, officers, shareholders, employees, agents, successors, assigns and legal representatives of Hampton Roads IcePlex; that this release agreement is to be governed by the laws of Virginia.
I agree and understand that Hampton Roads IcePlex will not be liable for, and that I RELEASE AND HOLD HARMLESS Hampton Roads IcePlex from any harm, injury, damage or loss of life or limb to me or others which may occur as a result of my ice skating or playing ice hockey at Hampton Roads IcePlex.
I understand that this release extends to liability for injuries from risk caused by the negligence of Hampton Roads IcePlex or its management or employees.
I understand that this release agreement is a legally binding contract which I willingly accept in order to ice skate or play ice hockey at Hampton Roads IcePlex; and I state that I have signed this document of my own free will.
PHOTO AND WEBCAM RELEASE ---- I give full permission to Hampton Roads IcePlex to use any ice skating photographs and/or video taken of me while participating in ice skating for publicity, security, or advertising purposes. Hampton Roads IcePlex has informed me that a live web cam is used for advertising purposes that is located in the Pro Shop, on the ice surface and the Arena.
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS RELEASE AGREEMENT BY READING IT BEFORE SIGNING IT.
MUST
______/______/______SIGN →______
DATE HERE SIGNATURE
ALL APPLICATIONS MUST BE SIGNED AND ACCOMPANIED WITH PAYMENT
NO REGISTRATION BY FAX; ONLY MAIL OR IN PERSON