2019 Ball Hockey Registration (Stirling Blues)

Print 2019 Ball Hockey Registration
Thank you for your interest in registering for Stirling Blues Minor Ball Hockey. Please fill out all sections of the form when registering. After submitting the form, you will be brought to a "Submit Payment" screen to complete the transaction through Paypal.
Player Information
  1. RadDatePicker
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    Open the calendar popup.
  2. Example: ###-###-####
  3. Please list any medical conditions or concerns that we should be aware of.
  4. Are you interested in helping us out this year?
  5. Please let us know if you require any special accomodations (ride sharing, etc) and we will do our best to accomodate you. We can not guarantee that we will be able to fulfill all requests however.
  1. RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF ALL RISKS AND INDEMNITY AGREEMENT

    I AGREE that I am over the age of 18 years (if under 18, parent or guardian agrees to the following on behalf of the player), and that I, the undersigned, agree that in consideration of myself being permitted to enter and use any one of the described lands, buildings, and premises used for ball hockey, and for ANY activities including, but not just limited to, ball hockey, on behalf of myself, my heirs, successors and assignors, DO HEREBY REMISE, RELEASE, INDEMNIFY, SAVE HARMLESS, DISCHARGE, AND FOREVER HOLD HARMLESS Stirling Blues Ball Hockey League, Stirling & District Recreation Centre, and the Township of Stirling-Rawdon, Stirling & District Minor Hockey Association, their directors, employees, volunteers, coaches, instructors, agents, and independent contractors and their heirs, successors, and assignors from any claims whatsoever arising by reason of any disease, deterioration of health, illness or injury to any person, including death, or for damage to, or loss of any of my property resulting from or arising from use of the lands and premises, from being present on the lands and premises, from participation in any program, from the use of any facilities or equipment located on the lands and premises, from acceptance of the advice of, or from the gross or will full negligence of the Stirling Blues Ball Hockey League, Stirling & District Recreation Centre, and the Township of Stirling-Rawdon, Stirling & District Minor Hockey Association Centre their directors, employees, volunteers, coaches, instructors, agents, independent contractors or any other persons using the lands and premises. The activities that I will be participating in will be inherently dangerous, and I will be exposed to risk of serious injury, disability, death, and risk of damage to or loss of property. I acknowledge that there may not be prompt access to medical assistance or treatment when participating in any activities, and I assume and accept any risk relating to the access to medical assistance and/or treatment. By signing this document, I acknowledge that I have read, understood and accepted the conditions of this waiver form as well as the rules attached as pertains to the league and are waiving certain legal rights, including the right to sue.

  2. PRIVACY CONSENT

     

    I do hereby consent to the collection and use of my personal information (including first and last name and hometown), personal images, athletic results and awards, prizes received, and verbal quotes, by posting on the website, or affiliated websites, of Stirling Blues Ball Hockey League, Stirling & District Recreation Centre, and the Township of Stirling-Rawdon, Stirling & District Minor Hockey Association  and/or by publishing in the newsletters of the following. I understand and agree that this information will not be sold to anyone without my prior written consent. I understand that my personal information can be viewed by anyone who accesses the abovementioned websites or publications, and that my consent can be withdrawn at any time, upon adequate prior written notice. I give this consent voluntarily and with the understanding that any of this information may be used in newspaper or magazine stories, posted on websites, and to verify my identity and registration in this event. 

Payment Information
  1. If you are paying by Paypal, please select in the dropdown box.
Human Validation
Printed from stirlingblues.ca on Sunday, July 21, 2019 at 4:51 AM