Adult Hockey Registration

Player Name	*
Player Date of Birth	*
Current USA Hockey Membership	*	Yes No
USAH Number
Address	*
City	*
State	*	- - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code	*
Phone	*
Email	*
Division	*	35+ Division 2/3 Division 3B/4 Division 5 Rookie
Team
Name That Appears on Credit Card	*
Billing Address	*
City	*
State	*	- - Choose One - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip	*
Credit Card Type	*	- - Choose One - - AMEX Visa Master Card
Credit Card Number	*
Expiration Date	*
CVC Code	*
Amount	*	- - Choose One - - $450.00 - Player Full Payment $337.50 - Additional Team Full Payment $225.00 - Goalie Full Payment $225.00 - Captain Full Payment $500.00 - Player Payment Plan $375.00 - Additional Team Payment Plan $250.00 - Goalie Payment Plan $250.00 - Captain Payment Plan
I authorize Icetown Carlsbad to charge my credit card	*	Yes
EMERGENCY CONTACT
Name	*
Phone	*
PLAY AT YOUR OWN RISK
The applicant and/or parent, legal guardian agrees that IceTown,Inc., and its staff will not be held responsible for any accidents that occur at IceTown,Inc., and/or any of its sponsored events. The applicant hereby agrees to release the IceTown,Inc., and staff from any liability that may result from loss or damage of equipment and/or personal injury whether physical and/or emotional. The applicant also authorizes the staff at IceTown,Inc., to act for them, according to their best judgment in any emergency requiring medical attention and also agrees to release IceTown,Inc., and its staff from any liability in regard to treatment of individuals.
The applicant also agrees and understands it is his/her responsibility to provide medical and dental coverage for the player registered above.
I agree to and understand the above policies.	*	Yes
PLAYER CONTRACT
1. I will follow the rules of IVAHL:
A. I will play by the rules of the game and in the spirit of the game.
B. I will respect my opponents.
C. I will respect the officials and their decisions.
D. I will maintain self-control at all times.
2. I will respect and acknowledge all good play-those of my teammates and my opponents.
3. I understand that as a player I am responsible for my actions and agree to serve the consequences of those actions. I agree to serve a game suspension for any and all game misconducts issued by the referee(s).
I agree to and understand the above policies.	*	Yes
WAIVER OF LIABILITY, RELEASE ASSUMPTION OF RISK & INDEMNITY AGREEMENT
For and in consideration of the undersigned participant’s registration with USA Hockey, Inc., its affiliates, local associations and member teams (all referred to together as USAH) and being allowed to participate in USAH events and member team activities, participant (and the parent(s) or legal guardian(s) of participant, if applicable) waive, release and relinquish any and all claims for liability and cause(s) of action, including for personal injury, property damage or wrongful death occurring to participant, arising out of participation in USAH events, member team activities, the sport of ice hockey, and/or activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant (and participant’s parent(s) or legal guardian(s), if applicable) may have are hereby waived, released and relinquished, and participant (and parent(s)/ guardian(s), if applicable) does(do) so on behalf of my/our and participant’s heirs, executors, administrators and assigns.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and assume all risks relating to ice hockey and any member team activities, and understand that ice hockey and member team activities involve risks to participant’s person including bodily injury, partial or total disability, paralysis and death, and damages which may arise therefrom and that I/we have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the “releasees” identified below. These risks and dangers include, but are not limited to, those arising from participating with bigger, faster and stronger participants, and these risks and dangers will increase if participant participates in ice hockey and member team activities in an age group above that which participant would normally participate in. I/We further acknowledge that there may be risks and dangers not known to us or not reasonably foreseeable at this time. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and agree that all of the risks and dangers described throughout this agreement, including those caused by the negligence of participant and/or others, are included within the waiver, release and relinquishment described in the preceding paragraph. I/We agree to abide by and be bound under the rules of USA Hockey, including the By-Laws of the corporation and the arbitration clause provisions, as currently published. Copies are available to USA Hockey members upon written request.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and assume the risks, if any, arising from the conditions and use of ice hockey rinks and related premises and acknowledge and understand that included within the scope of this waiver and release is any cause of action (including any cause of action based on negligence) arising from the performance, or failure to perform, maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said rinks, for negligent selection of certain releasees, or negligent supervision or instruction by releasees.
Participant (and participant’s parent(s)/guardian(s), if applicable) agree if any claim for participant’s personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever or wherever made or presented for participant’s personal injuries, property damage or wrongful death.
It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releasees. “Releasees” include USA Hockey, Inc., its affiliate associations, local associations, member teams, event hosts, other participants, coaches, officials, sponsors, advertisers, owners and operators of the premises used to conduct any event and each of them, their officers, directors, agents and employees.
Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers of ice hockey and understand these waivers and releases are necessary to allow amateur ice hockey to exist in its present form. Significant exclusions may apply to USA Hockey’s insurance policies, which could affect any coverage. For example, there is no liability coverage for claims of one player against another player. Read your brochure carefully and, if you have any questions, contact USA Hockey or a District Risk Manager.
I agree to and understand the above policies.	*	Yes
Security Code	*