Manalapan Cannons Hockey Club

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2021 MHC Summer Selects Registration Form

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

* Current team playing for and level?:

* Position Played?:

* 2021-22 USA Hockey Registration #:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

* Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I/we agree with the above *

I (we) assume all risks inherent to such participation and hereby release, absolve, indemnify and hold harmless the Manalapan Hockey Club, Inc. program, its partners, sponsors, officers, employees, and staff of any claim arising out of an injury to me (or the applicant, if different from the undersigned) requiring professional medical attention. I hereby authorize and request The Manalapan Hockey Club, Inc., its partners, employees, and staff to act on my behalf under prevailing circumstances in the event of an injury or in the event that I am not able to act for myself (or for the applicant) or cannot be reached. Furthermore, I make claim that I (or the applicant, if different from the undersigned) am covered under a medical insurance plan and agree to utilize said personal medical insurance plan in the event an injury requires medical attention.
Furthermore, I agree by electronically submitting these documents via the website www.leaguelineup.com/manalapanhockeyclub an electronic record of this agreement is memorialized. The Manalapan Hockey Club may use photographs taken during club events for promotional purposes.

PAYMENT

Payment for the tournaments can be sent in two ways:
1. Venmo to @dcarey82
2. Mail check to PO Box 557 Manalapan, NJ 07726

* indicates required fields

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2021 MHC Summer Selects Registration Form