Player Registration Form - Junior Hockey Network

PLAYER   R EGISTRATION   F ORM    

 

  N ame:   _ __________________________________________________________________________________    

 

  ( Last   N ame)   ( Middle   I nitial)   ( First   N ame)    

 

  A ddress:   _ __________________________________________________________________________________    

 

  ( Street)   ( City)   ( Postal   C ode)    

 

  B irth:   _ ___/____/____    

 

  D D   M M   Y R    

 

  P layer   T elephone:   R esidence   #   _ ____________________________    

                                                                         

                                                                        C ell#   _ ___________________________    

 

  P layer   E mail   A ddress:   _ ________________________________________________________________    

 

  P arent(s)   o r   G uardian   n ame(s)   (   U NDER   1 8)   _ ___________________________________________    

 

  P arent   e -­‐mail:   _ _________________________   P arent   e -­‐mail:   _ ________________________________    

 

  P arent   T elephone:   _ __________________________    

 

  H ealth   C ard   #   _ __________________________    

 

Position   1 st   P ref:   _ __________   2 nd   P ref:   _ ___________    

 

Team   P layed   W ith   L ast   Y ear:________________________________________________________________    

 

Height:   _ _______   W eight:   _ ________   S hot:   L eft   _ _____   R ight   _ _____    

 

Do   y ou   w ork:   N o   _ ___   Y es   _ ___   I f   y es:   F ull-­‐time   _ ___   P art-­‐time   _ ____    

 

School:   _ _______________________________________   G rade   E ntering   T his   Y ear:   _ ___________    

 

  R ELEASE   A ND   W AIVER    

 

In   c onsideration   o f   a cceptance   o f   t his   r egistration   i n   t he   C ochrane   C runch   T raining  

Camp,   I ,   f or   m yself,   m y   h eirs,   e xecutors,   a dministrators   a nd   a ssigns,   r elease   t he  

Cochrane   C runch   a nd   i ts   r espective   s ervants,   a gents   o r   e mployees   a nd   a ll  

organizers,   s ponsors,   r epresentatives,   o f   t he   C ochrane   C runch   T raining   C amp   a nd  

any   o ther   p erson   o r   o rganization   a ssisting   i n   t his   e vent   f rom   a ny   a nd   a ll   c laims,  

demands,   d amages,   a ctions   o r   c auses   o f   a ctions   a rising   o ut   o f   o r   i n   c onsequence   o f