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Mercer County Street Hockey Association
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2024 Summer Draft Registration
2024 MCSHA Summer Draft Registration / Player Waiver Form
1) The 2024 Summer Draft will be held at [Insert Sponsor Location] (date TBD). All are welcome to attend.
2) Every player is responsible to carry his/her own personal medical insurance, and sign/complete this registration/waiver form in order to participate.
3) The cost is $75 per player, payable in person (Cash or a check made out to the MCSHA).
4) You must be at least 18 years old to participate in the 2024 MCSHA Summer Draft Season.
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2023 - 2024 MCSHA Team:
Please Select Your Team From This List
Basement Dwellers
Blend Bar & Bistro
Broad Street Assassins
Classico Tomato Pies
Dasan Building Group Stormtroopers
District 2.5
The Force
Haldeman Subaru Sharks
Hamilton Tap & Grill Mustangs
Killarney's Publick House
John Casablancas / Nottingham Tavern Stonecutters
Playhouse VIPs
Mario & Frank's Warriors
New to the MCSHA / Returning Player
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Are you interested in being a captain?:
Please make a selection
Yes
No
Are you a goalie?:
Yes, I play goal
No, I do not play goal
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Position(s) played?:
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Preferred Shirt Size:
Please Choose One
Small
Medium
Large
X-Large
XX-Large
XXX-Large
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Full Name:
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Address (Street, City, State, Zip):
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City, State, Zip:
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Phone Number:
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Birthdate:
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Email:
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USA Ball Hockey Membership # USABH-:
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Medical Insurance Company / Group or Policy Number:
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Emergency Contact Name & Phone Number:
WAIVER INFORMATION
By applying to participate in a Hamilton Township Recreation Division activity, I hereby give my approval to participate.
I assume all risks and hazards incidental to such participation.
In case of emergency, I authorize the Hamilton Township personnel/trained volunteers to administer first aid treatment; to secure the services of a physician; to transport me to the nearest emergency facility for treatment; and to try to notify my identified contact person.
I do hereby release absolve, indemnify and agree to hold harmless the Mercer County Street Hockey Association, the Township of Hamilton, The Hamilton Township Division of Recreation, its supervisors, employees and all program volunteers, as well as any other persons connected with Hamilton Township, from any and all liability and from all claims relating to personal injury or property damage that I may sustain by reason of or related to my participation in the Mercer County Street Hockey Association.
I / We agree with the above.
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* indicates required fields