Westwood Roller Hockey Association

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Wildcats Roller Hockey Association 2019 - 2020 Registration Form

PLAYER INFORMATION

* Player First Name:

* Player Last Name:

* Player Address:

* Player Town:

* Player Date of Birth:

* Returning from Last Season:

Required for NEW player registration.
1. Two copies of recent photo
2. Two copies of birth certificate

* Level of Play:

* Position Played:

* Jersey Required:

If Yes, complete size, name and number.
If no, skip to Parental Information.

Jersey Size - Adult Sizes:

Name to be Printed on Back of Jersey:

Number to be Printed on Back of Jersey (enter 3 numbers, if not available we will notify):

PARENT INFORMATION

* Parent Contact #1 First Name:

* Parent Contact #1 Last Name:

* Parent #1 Email:

* Parent #1 Home Phone:

* Parent #1 Cell Phone:

Parent Contact #2 First Name:

Parent Contact #2 Last Name:

Parent #2 Email:

Parent #2 Cell Phone:

EMERGENCY TREATMENT AUTHORIZATION / CONTACT FORM

As the parent/guardian of the above named child, a minor, I hereby authorize treatment by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger my child's life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is only granted after a reasonable effort has been made to reach me (at the above listed phone numbers) or my designated alternate as listed below.

This release is granted for the current hockey season, which should span the time period from October 2019 through March 2020.

* Parent Signature - Treatment:

* Date:

* Player's Physician:

* Physician's Phone Number:

* Alternate Emergency Contact:

* Alternate Contact Phone Number:

* Alternate Contact Relationship:

Please note any special allergies, chronic illnesses or other medical conditions medical personnel should be aware of.

Medical Conditions:

RELEASE FOR PARTICIPATION IN WILDCATS ROLLER HOCKEY PROGRAM

This Hockey Program is intended to impart the ideals of good sportsmanship and team play, while helping our players to learn and to improve their hockey skills. The games are played in outdoor rinks throughout Northern Bergen County and involve physical contact. It also requires the use of the appropriate league approved equipment in order to participate. (i.e. HECC approved hockey helmet with full face shield, chin strap, mouth guard, padded gloves, skates, hockey girdle with hip protection, protective cup, full knee and shin protection, elbow protection, shoulder pads and stick with butt end) These games are competitive in nature.
As the parent/guardian of the above named child, I understand that by signing this consent form, I am willing to let my child participate in this program. I understand the activity as described above and I understand and consent to the conditions of the program as stated. I will not seek or pursue any claims against the instructors/coaches, supervisors/board members, the towns of Westwood, Twp of Washington, Paramus or other participating towns and/or any of its agents, employees or volunteers, unless such injury is caused solely by the intentional or gross negligent conduct of these designated supervisors/coaches.

* Parent Signature - Release:

* Date:

NORTH JERSEY YOUTH ROLLER HOCKEY PARENTS CODE OF ETHICS

1. I hereby pledge to provide positive support, care and encouragement for my child participating in youth roller hockey.
2. I will encourage good sportsmanship by demonstrating positive support for all players, coaches and officials at all hockey events.
3. I will place the emotional and physical well being of my child ahead of personal desire to win.
4. I will support the coaches and officials working with my child.
5. I will remember the game is for the players; not for the adults.
6. I will do my best to make roller hockey fun for my child.
7. I will insist my child treat other players, coaches, fans and officials with respect regardless of race, sex, creed or abilities and will do the same myself.
8. I promise to help my child enjoy the hockey experience by conducting myself as a respectful fan.
9. I will refrain from smoking at all hockey events.
10. I will adhere to the policies and rules of the NJYRHA.
11. I understand the failure to adhere to the above mentioned policies could result in my removal from a hockey event and my exclusion from future NJYRHA events.
12. I have read and understand the parental code of ethics.

* Parent Signature - Ethics:

* Date:

NORTH JERSEY YOUTH ROLLER HOCKEY PLAYERS CODE OF ETHICS

1. I will encourage good sportsmanship from fellow players, coaches, officials and parents at every game and demonstrate good sportsmanship myself.
2. I will do my best to listen and to learn from my coaches.
3. I will treat my coaches, other players and fans with respect, regardless of race, sex, creed or abilities, just as I expect to be treated.
4. I will encourage my parents to be supportive of my coaches, other players and officials at all hockey games.
5. I will refrain from the use of drugs, alcohol and tobacco.
6. I understand the failure to follow the above items could result in my suspension from the NJYRHA.
7. I have read the above mentioned rules and policies and will abide by the rules of the NJYRHA.

* Player Signature - Ethics:

* Date:

The registration fee is $135 for returning players who do not need a jersey and $160 for new and returning players who need a jersey. To help with the administration, we will be accepting PayPal and major credit cards as the form of payment. As such, credit card processing fees will apply and will be added at checkout.

New Player Documentation.
1. two copies of recent photo
2. two copies of birth certificate

* indicates required fields

IMPORTANT: Online Payment with credit cards is not active for this form

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Wildcats Roller Hockey Association 2019 - 2020 Registration Form