SVFD 3 on 3 Road Hockey Challenge

Size: px

Start display at page:

Download "SVFD 3 on 3 Road Hockey Challenge"

Christal Price
5 years ago
Views:

Submit all forms to Julie Ferguson (Town Clerk) at The Town of Shelburne in one of the following ways: a. Email: clerk@town.shelburne.ns.ca b. Fax: (902) 875-3932 c.

1 Water Street, Shelburne Registration starts at 10am Games start at 10:30am Registration Process 1. Complete the Team Registration form 2. Each player completes the Adult Registration Form or the Youth Registration Form as well as the safety waivers. 3. Submit all forms to Julie Ferguson (Town Clerk) at The Town of Shelburne in one of the following ways: a. b. Fax: (902) c. Mail: 168 Water Street 4. PO Box 670 Shelburne, NS B0T 1W0 Pay registration fee ($20/player) on site at the tournament. Only cash accepted. Guidelines & Rules Minimum of 3 players per team (three out, one goalie). Players must provide their own hockey stick and wear hockey gloves.

2 Players under 18 years of age are required to wear a hockey helmet with full face protection (cage). Teams are required to provide their own goalie gear which must include chest and neck protector, jock/jill, pads and full caged goalie mask. Each team will play a minimum of 3 games Games will consist of two 20 minute periods (non-stop time). Slap shots are not permitted and sticks are not to go above the waist for any reason. Additional rules will be reviewed with each team at the tournament.

3 Youth Registration Form (ages 15-17) or (13-14) Categories Name: Date of Birth: Age: Medical info (medical conditions, allergies, etc.): Parent/Guardian: Health Card # (child): Address: Home Phone: Cell#: Emergency Contact (Name): Phone: PHOTO RELEASE WAIVER The Municipal Recreation Department may take digital photos of children in our programs for use on websites, promotional materials, etc. Please indicate whether you agree or not to allow us to use your child s photo: YES NO WAIVER IN THE EVENT OF INJURY I, the parent/guardian of the above named child, who is a candidate for Programs of the Municipality of the District of Shelburne Recreation & Parks Department, do hereby give my consent to his/her participation in any of all of the activities of the program(s). I do hereby release and absolve the Municipal Recreation & Parks Dept. and the organizers, sponsors, and supervisors for the program(s) from any claim for injury of or losses suffered by my child during the course of program, no matter what the cause. I further agree that in the event of a claim by the third party against the Municipality resulting from any action by the child that I will indemnify and save the harmless Municipality. I assume all risks and hazards to which my child may be exposed as a result of his/her participation in the program(s). Parent/Guardian Signature: Date:

4 Team Registration Form Category: Adult (ages 18+) Youth (ages 15-17) Youth (ages 13-14) Team Name: Team Contact: Phone: Cell: Team Players (min 4): 1) Name: 2) Name: 3) Name: 4) Name: 5) Name: 6) Name: REMEMBER: Each player must fill out a Registration Form and sign safety waiver

5 Adult Registration Form (ages 18+) Name: Medical info (medical conditions, allergies, etc.): Address: Home Phone: Cell#: Emergency Contact (Name): Phone: PHOTO RELEASE WAIVER The Town of Shelburne may take digital photos of our programs for use on websites, promotional materials, etc. Please indicate whether you agree or not to allow us to use your photo: YES NO WAIVER IN THE EVENT OF INJURY I, do hereby give my consent to his/her participation in any of all of the activities of the program(s). I do hereby release and absolve the Town of Shelburne and the organizers, sponsors, and supervisors for the program(s) from any claim for injury of or losses suffered during the course of program, no matter what the cause. I further agree that in the event of a claim by the third party against the Town of Shelburne resulting from any action by the myself that I will indemnify and save the harmless Town of Shelburne. I assume all risks and hazards to which I may be exposed as a result of my participation in the program(s). Parent/Guardian Signature: Date:

6 Shelburne Volunteer Fire Department [referred to in this form as SVFD ] And Town of Shelburne [referred to in this form as ToS ] Street Hockey Tournament April 2, 2017 [Referred to in this form as the Event ] NOTICE: YOUR LEGAL RIGHTS ARE IMPACTED BY SIGNING THIS FORM YOU MUST READ THIS FORM CAREFULLY BEFORE SIGNING. YOUR SIGNATURE BELOW WILL BE TREATED AS CONFIRMATION THAT YOU READ THE FORM AND THAT YOU UNDERSTAND AND AGREE WITH ALL TERMS DESCRIBED BELOW. VOLUNTARY ACCEPTANCE OF ALL RISKS OF PARTICIPATION RELEASE AND WAIVER OF ANY CLAIMS AGAINST SHELBURNE VOLUNTEER FIRE DEPARTMENT and THE TOWN OF SHELBURNE SOLE LIABILITY FOR INJURIES CAUSED TO OTHERS I [print name], on behalf of myself, and on behalf of the following minors (persons under the age 19) who are participating in the event with my permission,,, [print name and age of all minors], ACKNOWLEDGE and AGREE AS FOLLOWS: That ball hockey is a fast and vigorous game, involving vigorous and sometimes dangerous physical activity. Playing or watching ball hockey in any setting, including but not only outside or on a street, carries real and significant risk of physical injury to me or others. I understand that the event will take place in whole or part outside, in a location not traditionally used or intended to be used for sporting events, and that greater risk of injury could arise as a result of that or of conditions reasonably flowing from that fact, including but not only added risks from exposure to weather and the elements or from walking, running or falling on paved or unpaved surfaces of the road or sidewalks, which I know may be uneven and possibly containing unusual hazards, such as holes or cracks or other imperfections that may increase the likelihood of falls or other methods of injury. There are many ways and kinds of injuries (including but not only serious traumatic injury, exacerbation of a known or unknown medical condition or death) that could be sustained by playing or being at or near a ball hockey game, some of which I might not foresee but which could still occur in the ordinary course of the Event, without indicating any failure by SVFD, ToS or others to take reasonable care for the safety of myself or others.

7 In spite of the above and other possible perils or expenses of doing so, I desire to participate in the Event, and in exchange for the privilege of doing so, BY SIGNING THIS FORM I INTEND TO INDICATE MY AGREEMENT THAT: I AM VOLUNTARILY ACCEPTING ANY AND ALL RISK of injury to myself or property, and to those of the minors for whom I am completing this form, that in any way arises from my/our participation or attendance at or in connection with the Event, whether as spectators or players at the time, and whether or not that injury arises from accidental or intentional behaviour of any other person, player or organization, and irrespective of whether SVFD or TOS or their employees, volunteers or other agents might have been able to prevent the injury through greater care or precaution; I AM VOLUNTARILY WAIVING or GIVING-UP ANY RIGHT TO CLAIM COMPENSATION directly or indirectly from SVFD, ToS, or their affiliates, sponsors, volunteers, employees or agents for any losses suffered by me, or by the minor(s) on whose behalf I am completing this form or by their family(ies) or estate(s), that in any way is caused by or arising from or in connection with my participation in the Event, whether as a player or spectator; I INTEND TO FORGIVE and RELEASE ANY AND ALL ORGANIZERS and SPONSORS OF THE EVENT, including but not limited to SVFD, ToS, their employees, volunteers and other agents from any legal liability, of any kind or nature, in any way arising from or in connection with my participation or attendance at the event, whether as a player or spectator; I AGREE TO COMPENSATE SVFD AND/OR TOS FOR ANY LOSSES OR EXPENSES that are caused, in whole or part, by my actions in connection with the Event, whether deliberate or accidental, and whether they are incurred by SVFD, ToS or their employees, volunteers or other agents or by third parties, such as other participants, officials or spectators, but only to the extent that my conduct is demonstrated to have contributed to the loss or injury; AND THAT THIS FORM HAS and IS INTENDED TO HAVE THE SAME FORCE AND EFFECT IN RELATION TO EACH OF THE MINORS LISTED ABOVE as it does or would have to me personally, and that I reasonably believe that I have legal authority to give permission and to agree to and complete this form on behalf of the minors I have identified above and I agreed to compensate SVFD and ToS in full for any losses or expenses either of them may incur if is determined that these commitments are not enforceable against the(se) minor(s), their family(ies) or estate(s ). BY SIGNING BELOW I AGREE THAT MY SIGNATURE CAN BE TREATED AS CONCLUSIVE CONFIRMATION THAT I HAVE READ, UNDERSTOOD AND AGREE WITH ALL OF THE ABOVE, which I do voluntarily and without duress, on behalf of myself and of any minor(s) listed above with intention that we each will be bound by the above terms. Signed at Shelburne, NS, this day of NAME and DOB OF PARTICIPANT(s) NAME OF WITNESS SIGNATURE OF PARTICIPANT SIGNATURE WITNESS

2017 Clinic Boys 8-12

Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649 Email: Recreation@greenwichct.org 2017 Clinic Boys 8-12 ACTIVITY NUMBER: 30401