Team:
First Name:
Last Name:
Date of Birth:
Age:
US Citizen: Yes No
Address:
City:
ZIP:
Phone:
Cell:
Email address:
Emergency Contact:
Emergency Phone:
Hometown:
USA Hockey Registration: Yes
No
Shot: Right Left
Position: Defense
Forward Center
Goalie
Other hockey teams you've played for:
Please list any individual or team goals you have for this year:
PARTICIPATION
AGREEMENT, RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF
RISK
To:
Cary Ice House, North Carolina Trailblazers and their owners,
officers, directors, agents, employees, and/or representatives.
ASSUMPTION
OF RISK:
I am aware that ice hockey involves certain inherent risks,
dangers and hazards which can result in serious personal injury.
As such, I hereby freely agree to assume and accept any and all
known and unknown risks of the injury while participating.
RELEASE
AND WAIVER OF CLAIMS AGREEMENT:
In consideration of allowing me to participate, I hereby agree
as follows:
TO
WAIVE ANY AND ALL CLAIMS
that I have or may in the future have against the Cary Ice House and
the North Carolina Trailblazers.
TO
RELEASE
Cary
Ice House. and North Carolina Trailblazers from any and all liability
for any loss, damage, injury or expense that I may suffer, as a result
of my participation in ice hockey.
I
HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING
THIS AGREEMENT I AM WAIVING
CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE
CARY
ICE HOUSE AND THE TRAILBLAZERS.
