Capital Thunder Youth Hockey

Transcription

1 Capital Thunder Youth Hockey Registration TRY-OUT CHECK LIST IMPORTANT: All financial obligations to your previous team must be fulfilled before any player may try-out. COST: $75 ($50 Early Bird if registered by midnight, May 31 st.) PRE-REGISTRATION REQUIREMENTS: Completed Player Registration Form Proof of USA Hockey Membership Register online for the upcoming season at USA Hockey Consent to Treat/Medical History Form USA Hockey Participant Code of Conduct (Must be signed by the PLAYER not parent) CAHA Concussion Form Capital Thunder Code of Conduct Skatetown Waiver of Liability Copy of Birth Certificate or Legal Proof of Residency with a Foreign Birth Certificate (only needed for non-returning travel players) AKA form notarized (if name differs from birth certificate) Age Consent Form (if playing up to the next age division such as a Mite aged player playing Squirt.) Please check the Capital Thunder for tryout schedules.

2 Capital Thunder Youth Hockey Registration PLAYER REGISTRATION FORM SELECT ONE: MITE ( ) SQUIRT ( ) PEEWEE ( ) BANTAM ( ) Player s Name: Birth Year: Male Female USA Citizen: Yes No* If No, What Country (* Must provide copy of Birth Certificate, copy of valid visa, and evidence of residency) Home Address: City: Zip: Home Phone #: ( ) - Position: Goalie Defense Forward Shoots: Left Right Team: (MUST BE) USA Hockey #: Parent #1 Address same as Player Home Address: Parent #2 Address same as Player Home Address: City: Zip: City: Zip: Work Phone: ( ) Cell Phone: ( ) Work Phone: ( ) Cell Phone: ( ) Parent/Guardian In what capacity are you willing to volunteer? Team Manager Score/Time Team Parent Team Webmaster Fundraising Tournaments Event Volunteer Penalty Box Attendant Other: INTERNAL USE ONLY: USAH CTYH CC Birth Cert Paid USAH Consent to Treat CAHA Concussion Foreign TO # USAH CC Skatetown AKA

3 Usa Hockey Consent to treat/medical History form This is to certify that on this date, I, as parent or guardian of, (athlete participant), or for myself as an adult participant, give my consent to USA Hockey and its medical representative to obtain medical care from any licensed physician, hospital, or clinic for the above mentioned participant, for any injury that could arise from participation in USA Hockey sanctioned events. If said participant is covered by any insurance company, please complete the following: Insurance Company: Policy Number: parent/guardian/adult participant signature: date: Excess accident insurance up to $50,000, subject to deductibles, exclusions and certain limitations, is provided to all USA Hockey registered team participants. For further details visit usahockey.com or contact USA Hockey at (719) 576-USAH. emergency ContaCt Name: Phone: Address: Physician s Name: Phone: Hospital of Choice: Completion of medical History information Below is optional medical History If the answer to any of the following questions is yes, please describe the problem and its implications for proper first aid treatment on the back of this form. Head Injury (concussion, skull fracture) Fainting spells Convulsions/epilepsy Neck or back injury Asthma High blood pressure Kidney problems Hernia Heart murmur Have you had (or do you currently have) any of the following? Have you had a recent tetanus booster? Yes No If yes, when? Are you currently taking any medications? Yes Allergies Diabetes Other No If yes, please list all medications on back. Has a doctor placed any restrictions on your activity? Yes No If yes, please explain on back. 3C rev 8/12

4 USA HOCKEY PARTICIPANT CODE OF CONDUCT NAME: To be read and signed by you as a member of Team: Participating in USA Hockey for the season. 1. No swearing or abusive language on the bench, in the rink, or at any team function. 2. No lashing out at any official no matter what the call is. The coaching staff will handle all matters pertaining to officiating. 3. Anyone who receives a penalty will skate directly to the penalty box. 4. Fighting will not be tolerated. Fighting will result in an appearance before a Discipline Committee. 5. There will be no drinking, smoking, chewing of tobacco or use of illegal substance at any team function. 6. I will conduct myself in a befitting manner at all facilities (ice rink, hotel, restaurant, etc) during all team functions. 7. Any player or team official who cannot abide by these rules or violates them will be subject to further disciplinary action. Signed: Date: Form 1-P Rev 02/09

5 California Amateur Hockey Association Concussion Awareness and Protocol Parent/Guardian Acknowledgement Form Youth Hockey Player Name: Season: Level of Play: Program: 1. I understand that the California Amateur Hockey Association has adopted concussion-related education, awareness and protocol into their Guidebook and Rules of Play. 2. I understand the following guidelines and protocol exist, and will respect them if they must be instituted with the above-named player: a. An athlete who is suspected of sustaining a concussion or head injury in an athletic activity shall be immediately removed from the activity for the remainder of the day. Removal from play can be at the request of a coach, official, team manager, parent/guardian, or the player. b. Athlete shall not be permitted to return to the activity until he/she is evaluated by a medical professional trained in the management of concussions. Acceptable evaluators must be medical professionals with one of the following medical license designations: MD, DO, Neurologist, Neuropsychologist. c. Further, the athlete shall not be permitted to return to activity until he or she provides the approved and completed Concussion Release form to the Club, from the evaluating medical professional. 3. Should it be determined that a player needs to be removed from play, I/we understand that the protocol outlined herein must and will be followed for the safety of the player. Further, I/we understand that the above named player will receive concussion education during the course of the season. 4. I understand that if a suspected concussion has occurred and protocol has been enacted for the above named player, there is no review period or negotiation as to the course of action and return to play outside of the recommendations of the evaluating medical professional who has been selected to treat the player. 5. I/we understand that if I/we suspect the above named player has experienced a concussion or exhibits behavior that suggests concussion-like symptoms, I/we have the authority to remove the player from play and begin the concussion protocol with a medical professional of my/our selection who meets the criteria of an acceptable evaluator. By the signature/s below, I/we acknowledge responsibility for the above named player in the current season, and agree to all of the information stated herein. Name Date Name Date

6 Capital Thunder Player Code of Conduct The Capital Thunder Hockey program believes strongly in the values of teamwork, sportsmanship and leadership through example. As a player in the Capital Thunder organization, your actions reflect not only on you, but also on your teammates, your coaches and the Thunder program. Player Code of Conduct Agreement As a player involved in the Capital Thunder Hockey program, I agree to conduct myself responsibly within the facilities, both home and away, No foul or abusive language Players must use their assigned locker rooms No shooting pucks or balls in the locker rooms or within the facilities No spitting on the floors Players must be fully dressed (pants and shirt) when they exit the locker rooms Valuables should be placed in the safe in the locker room or in a locker. Do not leave valuables in your hockey bag A CAHA screened adult MUST be in the locker room at all times when players are present Trashing of other players belongings, stealing, throwing trash and tape, taking advantage of younger or smaller players is not acceptable in either the locker rooms or the arena Locker rooms need to be cleaned after they are used I understand by signing this agreement I promise to uphold the Capital Thunder Player Code of Conduct. I realize violation of this Code of Conduct may result in loss of ice-time, suspension for part of or all of a game or practice, or even ejection from the Capital Thunder program. Additionally, players and their families may be held financially responsible for damage caused by failure to adhere to the Code of Conduct policies. Dues will not be refunded or adjusted in the event of any suspension. I,, fully understand the Player Code of Conduct and agree to adhere to rules and policies as outlined. Player signature Parent/Legal Guardian signature July, 2012

7 Waiver and Release of Liability, Assumption of Risk & Indemnity Agreement In consideration of being allowed on Roseville Sportworld, Inc. (RSI or Skatetown) premises (including the parking lot), to attend, participate in, spectate, or volunteer in Skatetown on-ice or off-ice activities, and/or to use Skatetown equipment and facilities, I, the undersigned, (Participant) and/or my parent(s)/guardian(s) agree: 1. Waiver and Release of Liability. a. Participant and/or Participant's parent(s)/guardian(s) forever release and discharge Skatetown and all of its shareholders, directors, officers, employees, agents, instructors, coaches, volunteers, and affiliated entities/companies ( Releasees ) from any and all liability for and forever waive all claims/causes of action for personal injury, disability, property loss/damage or death arising out of, relating to, or caused by activities at Skatetown and/or Releasees negligence. This waiver and release applies to all activities at Skatetown including, but not limited to, ice skating, ice skating lessons, speed skating, ice go-kart riding, ice tricycle riding, Zamboni riding, ice hockey, broom ball, off-ice activities, including use of party rooms, restaurant and other facilities, activities incidental to those activities, and rental and use of equipment used for on-ice or off-ice activities ( Activities ), whether as an active participant, attendee, spectator, or volunteer. b. Participant and/or Participant s parent(s)/guardian(s) intend this waiver and release to be a complete release of Releasees from any and all claims/causes of action for negligence, failure to perform maintenance, to inspect, to supervise or to control the premises, existence of and/or the failure to warn of dangerous conditions existing on the premises, and negligent supervision, training or instruction of employees, volunteers, coaches or any other agent of RSI and any and all rights to recover for personal injuries, disability, property loss/damage or death arising out of, relating to, or caused by activities at Skatetown and/or Releasees negligence. c. Participant and/or Participant's parent(s)/guardian(s) agree not to sue Releases to recover for personal injuries, disability, property loss/damage or death arising from, relating to, or caused by Activities at Skatetown or Releasees negligence. 2. Assumption of Risk of Injury, Disability, Paralysis, Death. Participant and/or Participant's parent(s)/guardian(s) acknowledge and understand participating in or spectating Activities involve risks including bodily injury, partial or total disability, paralysis, and death. These risks and dangers may be caused by the actions/non-actions of the Participant, Participant s parent(s)/guardian(s), or other participants or spectators. It is further acknowledged there may be risks and dangers not known or reasonably foreseeable at this time to Participant or Participant s parent(s)/guardian(s). Participant and Participant s parent(s)/guardian(s) nevertheless assume all risks arising from or related to the conditions and use of Skatetown s ice rinks and premises, and participation in or spectating Activities at Skatetown whether the risks are known or unknown, whether as a participant or non-participant. 3. Agreement to Indemnify. Participant and/or Participant's parent(s)/guardian(s) agree to indemnify and hold harmless Releasees from all liability, claims, demands, causes of action, charges, expenses, costs and attorney fees arising out of or related to Activities at Skatetown whether caused by any act or omission of Participant, Releases or otherwise. Participant and/or participant's Parent(s)/guardian(s) also agree to pay Skatetown for any and all damage to its property, facilities and equipment caused by them. 4. Consent and Agreement. Participant and/or participant's Parent(s)/guardian(s) acknowledge they have read the above, have not relied upon any representations of RSI or Releasees, and are fully aware of the potential dangers of Activities on Skatetown premises. Minor participant s parent(s)/guardian(s) agree they have assessed their minor s age, experience and capabilities, understand the nature of the activity(ies) in which their minor will participate, and consent to such participation under this Agreement. This Agreement is effective against Participant, Participant s parent(s)/guardian(s)) and each of their heirs, executors, administrators and assigns. Consent to Treat and Photograph I hereby certify that I give my consent to Skatetown and its medical representative to obtain medical care from any licensed physician, hospital or clinic for the Participant identified below, in the event any injury arises from participating in Skatetown sanctioned events. As a further condition of my attending, participating, spectating, or volunteering in on-ice or off-ice activities at Skatetown, I grant Skatetown perpetual and non-revocable permission to use my name, photographs and video in which my image, voice and likeness appears in connection with my participation in or spectating activities at Skatetown and further grant permission to display, publish, distribute, use, print and reprint such images, voice and likeness, and the right to employ such images, voice or likeness in advertising and promotions for Skatetown, including any advertisements or media and electronic displays and transmissions thereof (herein Likeness Rights ). I release Skatetown from any and all liability for damages for use in any manner or media of the Likeness Rights, and waive any and all claims and causes of action for damages for use of the Likeness Rights, including but not limited to: unauthorized use of my likeness, image, voice, character or persona; violation of my right of publicity or privacy; and for copyright or moral rights infringement, defamation, or being cast in a bad light. I understand and agree that this Agreement is a full and final release covering all known and unknown and unanticipated injuries, debts, claims or damages to me that have arisen or may have arisen from any matters, acts, omissions or dealings released in this agreement, including but not limited to the use of the Likeness Rights. I HAVE READ THE ABOVE AND AGREE. Date Participant Name [Print] Participant Name [Signature] Date Participant s Parent or Guardian Name [Print] Participant s Parent or Guardian Name [Signature] (required if participant is under the age of 18) \\Server2\Shared Data\General\Forms\Waiver of Liability\ Waiver of Liability For All Purposes and Photo Consent.docx

8 Waiver and Release Agreement (Capital Thunder Youth Hockey Club) This Agreement is by and between, or Participant s parent or legal guardian if Participant is under the age of eighteen (18) years or otherwise lacks legal capacity (collectively, the Participant ), and Capital Thunder Youth Hockey Club ( CTYH ). In consideration for the opportunity to attend, volunteer and/or participate in activities offered at or by CTYH (the Activities ), Participant certifies, warrants, and represents to CTYH, affiliates, members, directors, officers, coaches, employees, agents, heirs and assigns, and any sponsors or promoters of the Activities, and all others acting with CTYH authority (collectively, the Releasees ), and Participant hereby agrees to the following: ACTIVITIES & RISKS. The Activities, including, but not limited to, instruction, warm ups, drills, games, social gatherings, clinics, spectating and any other individual or group activities and events presented by CTYH, whether taking place at Skatetown Roseville or any other place, may involve full or partialcontact sporting interaction, require good physical and mental health and fitness, and can be HAZARDOUS AND DANGEROUS TO PARTICIPANTS. Involvement with the Activities exposes Participant to risks of serious bodily injury, including PERMANENT DISABILITY, PARALYSIS OR DEATH (the Risks ). Such Risks include, but are not limited to, those related to contact and/or participation with other Participants, spectators, equipment, playing field, facility and/or fixed objects; falls, mishaps, collisions and/or rough play; adverse weather conditions; flaws and defects in equipment and facilities; and negligent facility maintenance, instruction, supervision and participation. Risks may be caused by the actions or inactions of Participant or others, the condition of the facilities in which the Activities take place, or the NEGLIGENCE OF THE RELEASEES. Some Risks cannot be predicted or controlled, and there may be other risks and social and economic losses not known to Participant and/or the Releasees and/or which are not readily foreseeable at this time. WARRANTIES & REPRESENTATIONS. Participant warrants, represents and agrees that Participant is qualified to participate in the Activities and is free of mental and/or physical condition, ailment or injury, medical or otherwise, which could, independently or combined with any other circumstance: (i) impair, prevent or prohibit Participant from engaging in the Activities, or (ii) be affected, aggravated or worsened in any way, directly or indirectly, as a result of Participant s involvement with the Activities. Participant further agrees that Participant understands the Risks associated with the Activities and will immediately discontinue any further involvement if, at any time, Participant believes conditions to be unsafe. LIKENESS & PUBLICITY. The Releasees shall have the perpetual and irrevocable right to use, reproduce, print, publish and disseminate in all manners and media Participant s name, image, voice, appearance and other identifying information provided in connection with the Activities (the Likeness ), and to record, broadcast and otherwise exploit the Likeness in any and all promotions, advertisements and/or public displays or announcements of any kind and in any and all media. The Releasees shall have full and exclusive ownership and control of any video, photograph or recording of the Likeness (the Material ). Participant shall have no rights to such Material, and the Releasees may use, alter or modify all or part of the Material and Likeness, regardless of whether Participant is recognizable. RELEASE & INDEMNIFICATION. Participant agrees that s/he understands and knowingly and freely assumes the Risks associated with the Activities, whether or not expressly described herein. Participant acknowledges that s/he receives material benefit from the Activities and, in consideration, agrees to fully and completely, to the fullest extent permitted by law: (i) WAIVE, RELEASE AND DISCHARGE the Releasees from and with respect to any and all liability, claims, damages, losses, expenses, demands,

9 Waiver and Release Agreement (Capital Thunder Youth Hockey Club) suits, actions, fines and/or judgments, including without limitation reasonable attorneys fees, court costs and litigation expenses (the Claims ), related to or arising from the subject of this Agreement, including, but not limited to, bodily injury, personal injury, death, discrimination, property damage or the Releasees negligence; and (ii) INDEMNIFY, DEFEND AND HOLD HARMLESS the Releasees from any Claims asserted against the Releasees caused by, in whole or in part, or arising from, directly or indirectly, Participant s involvement with the Activities and/or breach of this Agreement. PARTICIPANT WAIVES ANY RIGHTS UNDER 1542 OF THE CIVIL CODE OF THE STATE OF CALIFORNIA, AND ALL SIMILAR LAWS OF ANY JURISDICTION, PROVIDING: A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor. ENTIRE AGREEMENT. THIS AGREEMENT CONSTITUTES THE ENTIRE AGREEMENT BETWEEN PARTICIPANT AND CTYH WITH REGARD TO ITS TERMS. Participant agrees that s/he: (i) understands all terms of this Agreement, (ii) has full knowledge of its content and significance, including that Participant is giving up legal rights that may otherwise be available, and (iii) signs this Agreement freely and voluntarily without inducement or coercion. This Waiver and Release Agreement is intended to be as broad and inclusive as California law allows and, if any portion is held illegal, invalid or unenforceable, the balance will continue in full force and effect, and such portion will be given effect to the maximum extent possible by narrowing or limiting only that aspect found overbroad or unenforceable. Participant or Parent Signature Date Print Name Contact and/or Phone Number Address PARENTAL CONSENT & RELEASE (if applicable). (the Parent ) hereby agrees that s/he has executed the foregoing Agreement on behalf of Participant, a minor under the age of eighteen (18) years or otherwise lacking legal capacity. The Parent represents that s/he has the legal capacity and authority to act for or on behalf of Participant, and agrees to bind the Parent, Participant, and each of their agents, legal representatives, successors, heirs and assigns to the terms of this Agreement. The Parent hereby releases, indemnifies and holds harmless the Releasees from Claims related to or arising from the Parent s legal capacity or authority to act for or on behalf of Participant or the Parent s execution of this Agreement. Parental Signature Relationship to Participant Date