08BRegistration

08B Crown hockey registration

Player Name *

First

Last

DOB (xx/xx/xxxx) *

2017-2018 Level of Play *

Position(s) *

Address *

City *

State *

Zip *

Parent #1 Name *

Parent #2 Name *

Parent #1 Email Address *

Parent #2 Email Address *

Parent #1 Phone (H) (XXX-XXX-XXXX) *

Parent #1 Phone (C) (XXX-XXX-XXXX) *

Parent #2 Phone (H) (XXX-XXX-XXXX) *

Parent #2 Phone (C) (XXX-XXX-XXXX) *

CROWN HOCKEY
AGREEMENT, WAIVER AND MEDICAL RELEASE FORM

MEDICAL INFORMATION/RELEASE

Health Insurance Co. & Policy # *

Please read and sign and date the following:

It is the purpose of this agreement to exempt, waive, release and relieve RAO Enterprises DBA Doug Woog Hockey Development from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of RAO Enterprises DBA Doug Woog Hockey Development. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledges, understands and assumes all risks relating to ice hockey and any member team activities, and understands 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 have full knowledge of said risks. This waiver and release applies to all claims, including claims due to injury, disability, death, or loss or damage to person or property, even if caused by the ordinary negligence of RAO Enterprises DBA Doug Woog Hockey Development, and the other owners of any facilities. This release shall be binding on me and my heirs, legal representatives, successors and assigns to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforced. Pursuant to Minn. Stat. §604.055, nothing in this release purports or intends to waive liability for damage, injuries, or death resulting from conduct of RAO Enterprises DBA Doug Woog Hockey Development that constitutes greater than ordinary negligence.
“RAO Enterprises DBA Doug Woog Hockey Development” shall mean and include RAO Enterprises DBA Doug Woog Hockey Development, Doug Woog Summer Development Program, Crown Hockey – AAA Spring/Summer hockey teams, Doug Woog 3 on 3 hockey camp/clinic, member teams, event hosts, other participants, coaches, officials, sponsors, advertisers, and each of them, their officers, directors, agents and employees.

I certify that the above-mentioned individual is in good health, and can participate without restriction in an RAO Enterprises DBA Doug Woog Hockey Development event as defined in the preceding paragraph. I release RAO Enterprises DBA Doug Woog Hockey Development of any liability from an RAO Enterprises DBA Doug Woog Hockey Development event arising from an unknown condition, medical or otherwise. I agree to allow RAO Enterprises DBA Doug Woog Hockey Development to seek treatment for the above named person in case of an emergency. I give consent for ambulance transportation. I agree to notify RAO Enterprises DBA Doug Woog Hockey Development of any changes in the medical status of the above named person. If there are any medical or physical conditions or restrictions that RAO Enterprises DBA Doug Woog Hockey Development needs to be aware of with respect to the above-mentioned participation, I have noted them below.

Medications: *

Allergies (including any allergies to any medications): *

Present/Existing Medical Conditions: *

Do we have your approval to administer Tylenol/Ibuprofen to your child if deemed necessary? *

Yes No

I certify that I am a parent or legal guardian for the above mentioned. *

Yes No

Check this box to indicate you have read and agree to the terms of the Crown Agreement, Waiver and Release. *

Yes

Payment

Name on Credit Card *

Billing Address for Credit Card (Address, City, State, Zip) *

Email for Credit Card Receipt *

Visa or MasterCard *

Visa MasterCard

Amount to Charge (Does not include 3.5% service fee) *

$150 (Charge $150 down payment only today. (Charge $415 on 2/1 and $400 on 3/1) $965 (Charge in full today)

Credit Card Number (No Dashes) *

Expiration (xx/xx) *

By submitting your name below you are authorizing us to use this as your electronic signature. *

First

Last

Comment *

Submit

08B Crown hockey registration

CROWN HOCKEYAGREEMENT, WAIVER AND MEDICAL RELEASE FORM

Payment

CROWN HOCKEY
AGREEMENT, WAIVER AND MEDICAL RELEASE FORM