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Name:____________________________________________Age______Phone:_________________
Address:________________________________________City__________________Postal
Code________
e-mail(please print very clearly)____________________________
Allergy/Medical conditions________________
Please circle position preferred:....GOALTENDER......DEFENCE.......FORWARD
If you played in the
Halton Mens League last winter, what division did you play in?__________________
If not, 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 WINTER
2009-10 (please circle your choice of Division)
a: 18 game schedule - 30+ years old - Sunday mornings..........................
Registration fee: $389.00 + $10.00 refundable sweater deposit -Total $399.00
b: 18 game schedule - 30+ years
old Sunday/Monday nights...................... Registration fee: $389.00 + $10.00 refundable sweater deposit -Total $399.00
c: 18 game schedule - 50+ years old Sunday mornings ........................... Registration Fee: $389.00
+ $10.00 refundable sweater deposit -Total $399.00
d. 18 games schedule - 40+ years old - Primarily Wed
nights (some Sun nts) ...... Registration Fee: $389.00 + $10.00 refundable sweater deposit -Total $399.00
I would
like to play with: _______________________________________ (name one player only, no guarantees, league decision final, requests
received after Sept 23 may not be given consideration)
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 and the Town of Oakville. 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 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 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. NO REFUNDS, NSF CHEQUES SUBJECT TO $25 ADMINISTRATION
FEE.
PLAYER SIGNATURE ________________________DATED THIS ________DAY OF ________, 20____
MAIL
CHEQUES AND APPLICATION FORM TO:Mr. D. Jenner, 540 Lakeshore Rd W Oakville ON L6K 3P1
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