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Name:____________________________________________Age______Phone:_________________
Address:________________________________________City__________________Postal
Code________
e-mail(for stats, newsletters)____________________________ Allergy/Medical conditions________________
Please circle appropriate choice:....GOALTENDER......DEFENCE.......FORWARD
Where did you play last year?_________________________Where
did you play 10 years ago?_______________
On a 1-10 scale, 1 indicating no experience, 5 house league, 7 competitive,
9 university, your rating is? ________
REGISTRATION FEES SUMMER 2009
18 game schedule
- ages 30-55 Registration fee: $346.00 + $15 refundable sweater deposit + GST = $379.00
I would like to play with: _______________________________________ (name one player only)
PLAYER
HEALTH CERTIFICATION: Upon signing this application, the player certifies he is in good normal health, is properly equipped
(full hockey equipment mandatory) and has no abnormal handicaps.
PLAYER/SPECTATOR CONDUCT: The Halton Mens Hockey Inc.
operates on Municipal property with the permission of Appleby College, the Town of Oakville and the City of Burlington. To
this end, players, parents/guardians and participants will respect the facilities and grounds and will abide by the rules
set forth by the facility and staff.
PARTICIPANT WAIVER AND INFORMED CONSENT: To whom it may concern: I, the undersigned,
authorize Halton Mens Hockey Inc. and/or Appleby College and/or Town of Oakville and/or City of Burlington and/or anyone acting
on their behalf to acquire necessary medical aid that may be required as a result of any accident or injury which may be sustained
by me. I have been warned and informed via this document that insurance coverage is not provided and there are serious physical
risks associated with hockey, including, but not limited to falls and/or collisions with stationary objects, other players,
skates pucks and sticks. My signature below indicates my informed consent to participate knowing the risks involved. And I
hereby indemnify and save harmless Halton Mens Hockey Inc. and/or Appleby College and/or Town of Oakville and/or City of Burlington
and/or anyone acting on their behalf from any and all actions, claims and demands for damages, loss or injury however arising
which here to after may have been sustained by me while participating in any activity or facility operated by Halton Mens
Hockey Inc. and/or Appleby College and/or Town of Oakville. My signature below indicates that I have the legal right to assume
the conditions above on behalf of the player named above. My signature below also indicates that I have thoroughly read and
agree to all of the terms above.
PLAYER SIGNATURE ________________________DATED THIS ________DAY OF ________,
20____
MAIL CHEQUES & APPLICATION FORM TO:D. Jenner, 540 Lakeshore Rd. West, Oakville L6K 3P1
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