Name:

Email:

Address:

City: Province: Postal Code:

Work Telephone: Home Telephone: Emergency Telephone:

Age: Birthdate:

Level of hockey last played:

Care Card Number:

Name of Parent/Guardian:

Group 1 9 - 12 Years

Group 2 13 - 16 Years

WAIVER

I understand that hockey and the sports activities of a hockey program involve inherent and other risks of injury. I voluntarily agree to expressly assume all risks of injury which may result from my child's participation in the Girls Only Hockey Program.

I agree to release Dianna Hartnell operating the "Girls Only Hockey Program", its employees, instructors, owners, affiliates and agents from all liability for personal injury, property loss and damage, including all liability which results from the negligence of the Girls Only Hockey Program, employees, instructors, owners, affiliates and agents.

I, the undersigned, verify that I am the parent or guardian of the child participating in the Girls Only Hockey Program and state that I have read and understand the terms of this liability release agreement.

Accept

Decline