2019-20 Major Midget Online Registration Form (Huron-Perth Lakers AAA Minor Hockey Association)

Print 2019-20 Major Midget Online Registration Form

PLAYER INTENTIONS

Please answer the following questions

Are you interested in Summer Midget Skates?^*
YESNO
Are you prepared to Sign a HPL Midget Contract Prior to August 25th?^*
YESNO

Player Information1

Complete all fields below:

Player's Name^*

Date of Birth:^*

Open the calendar popup.

Enter in mth/day/year format eg: 6/16/1999

Father's Name^*
Mother's Name:^*
Address:^*
Town/City:^*
Postal Code:^*
Municipality:^*

(taxes paid to)

Player has lived at this residence since:^*

Open the calendar popup.

select approximate date or enter in mth/day/year format eg: 6/16/1999

Lives with:^*
BothFatherMother
Check one
Home Phone:^*

Example: ###-###-####
Mother's Cellphone:

Example: ###-###-####
Mother's Email Address:

Example: [email protected] Your submission will be sent to this address.
Father's Cellphone:

Example: ###-###-####
Father's Email Address:

Example: [email protected] Your submission will be sent to this address.
Emergency Family Member:

(name)
Emergency Family Member Cell or Home #:

Example: ###-###-####
Allergies / Medical Conditions we need to be aware of:
Local Hockey Centre:^*
Position Played:^*
Shoots/Catches^*
LeftRight
Previous Team: 2018-2019^*
Previous Team: 2017-2018^*
Off Season Training (if any):

ACCEPTANCE OF RISK / WAIVER OF RESPONSIBLITY
I am aware and approve of my child's registration to participate in tryouts for the Huron-Perth Lakers AAA Minor Hockey Association. I understand that my child is in good health except as noted above. I relinqish to the player's coach/instructor the right to instruct, direct and, as appropriate, discipline the player during the specific team tryouts the player is participating in.

I hereby release, remise and forever discharge the Huron-Perth Lakers AAA Minor Hockey Association and their heirs, executives, coaches, trainers, managers, committees and instructors of all actions, causes of actions, damage claims and demands whatsoever which may arise from any incident to the participating child and/or player and/or property while practicing, playing, traveling to or from hockey-related events arranged by, through or supervised by said association.

I agree to the terms and conditions stated above^*
OPT-OUT PROVISION (PRIVACY ACT)
I acknowledge and understand that, for the purposes of offering additional products and services that may be of interest to the participant or the participant's family, Hockey Canada and/or the Huron-Perth Lakers AAA Minor Hockey Association may use or disclose the participant's name and address collected on this form to third parties.

As the above-mentioned participant, or the participant's legal guardian, if you do NOT wish that information used or disclosed for the purpose of offering you such additional products and services, please indicate below.

I do NOT wish information on this form disclosed to third parties.