WTILHA

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WTILHA Fall 2018 Registration

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

* Birthdate:

Email:

Gender:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Home Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Cell Phone:

Phone:

* Player skill Level:

* Willing to help with this league activity:

The West Tennessee Inline Hockey Association follows the latest issued Official Rules of USA Hockey Inline and expects the players, coaches, and referees/officials to adhere to these rules.

I, the parent/guardian of the named player on this application for Inline Hockey hereby give my approval for his/her participation in any activities of the West Tennessee Inline Hockey Association during the season. I assume all risks and hazards incidental to participation in these activities. I hereby waive, absolve, release, indemnify, and agree to hold harmless the West Tennessee Inline Hockey Association, its officers, sponsors, coaches and referees, for any claim arising out of injury to my child to or from practice sessions, games, and any other activities of said organization. I will furnish a birth certificate for my child upon request from the League Director. All stated information on this form is true to the best of my knowledge.

I/we agree with the above *

* indicates required fields

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WTILHA Fall 2018 Registration