2005 REGISTRATION START DATE:

February 1st-May 31st: $250 (plus insurance)

(If you are signing up after start dates dues will be prorated)

 

PLAYER INFORMATION:( Please print clearly)

 

Name:__________________________________DOB:_________

Mailing Address________________________________________

_____________________________________________________

Phone:__________________Email:________________________

Emergency contact:____________________Phone:____________

      _______________________________________________

Hockey experience:  College     High School     Other:___________

Position:        Forward              Defense     Goalie

 

In consideration of being permitted to register and participate in the Nantucket Women’s Hockey at the Nantucket Ice Rink, and other consideration, the sufficiency of which is hereby acknowledged, and being fully aware of the inherent risk of bodily injury, partial or total disability, paralysis and death inherent to ice hockey, even in a so-called “no-check” league, I hereby forever release and discharge Nantucket Women’s Hockey, Nantucket Ice; and their directors, officers, employees, agents, and injury, damages, costs, claim or demands which I will, shall, or may suffer or receive by reason of said commenced against releases as a result of my participation what I will defend, indemnify and save harmless releases from any and all such claims or causes of action.  This release shall be binding on my heirs, assigns, executors and administrators.

 

Dated:______________  

 

Signature:__________________________________________

 

(If under 18 years of age please include parent’s)

 

Signature:___________________________________________

 

 

Nantucket Women’s Hockey will meet Tuesdays, 7:00-8:20PM