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Enter today's date (mmm-dd-yy)
* required
Player Name (First, Last)
* required
Parent's email
* required
Street Address
* required
City
* required
Postal Code
Telephone
* required
Player's Year of Birth
Medical issues we should be aware of:
I would like to play with (name one player only - no guarantees)
Check level of hockey played this past winter:
Boys AAA
Boys AA
Boys A
Girls AA, A
Preferred position (no guarantees)
Forward
Defence
Goal
Parents - Are you able to coach your child's team?
Yes - Coach
Yes - Assistant Coach
No
Parents - Are you able to sponsor your child's team? (for info on how your child can play for "free",
click on sponsorship link above)
Yes - please contact me for sponsorship details
No
PLAYER HEALTH CERTIFICATION: My acceptance selection certifies
that the player is in good normal health, is properly equipped (full hockey equipment mandatory) and
has no abnormal handicaps. My acceptance selection also confirms I have the authority
to complete this application on behalf of the child named above. Registration is
conditional on accepting these terms by checking the appropriate box below.
Yes - I agree with these terms
No - I do not agree with these terms and understand my registration will not be accepted
PARTICIPANT WAIVER AND INFORMED CONSENT: To whom it may concern:
I, as the submitter of this form, authorize The Ajax Summer Minor Hockey League and/or 771227 Ontario
Ltd. and/or Town of Ajax and/or anyone acting on their behalf to acquire necessary
medical aid that may be required as a result of any accident or injury which may
be sustained by my child (named above). I have been warned and informed via this form that insurance coverage
is not provided and there are serious physical risks associated with hockey, including, but
not limited to falls and/or collisions with stationary objects, other players,
skates pucks and sticks. My acceptance selection indicates my informed consent to
allow my child to participate knowing the risks involved. And I hereby indemnify and save harmless the The Ajax Summer
Minor Hockey League and/or 771227 Ontario Ltd. and/or Town of Ajax and/or anyone
acting on their behalf from any and all actions, claims and demands for damages,
loss or injury however arising which here to after may have been sustained by my child (named
above) while participating in any activity or facility operated by The Ajax Summer Minor Hockey League and/or
771227 Ontario Ltd. and/or Town of Ajax. My acceptance selection indicates that
I am a Parent/Legal Guardian/Adult participant having the legal right to assume
the conditions above on behalf of the player named above. My acceptance selection also indicates that
I have thoroughly read and agree to all of the terms above. Registration is conditional on accepting
these terms.
Yes - I agree with these terms
No - I do not agree with these terms and understand my registration will not be accepted
PLAYER/PARENT/GUARDIAN CONDUCT: The Ajax Summer Minor Hockey
League and/or 771227 Ontario Ltd. operates on Municipal property with the permission of the Town of
Ajax. To this end, players, parents/guardians and participants will respect the
facilities and grounds and will abide by the rules set forth by the facility and
staff as well as respecting and abiding by League rules and decisions. My acceptance selection indicates acceptance by
the Player, Player's Parents and/or Player's Guardians. Registration is
conditional on accepting these terms by selecting the appropriate box below.
Yes - I agree with these terms
No - I do not agree with these terms and understand my registration will not be accepted
PAYMENT INFORMATION Credit Card Type
VISA
Mastercard
Credit Card Number
* required
Expiry Date (mm-yy)
* required
3 Digit CVV Code
* required
I consent to charge my credit card $289.00 ($255.75 & HST) for Summer Hockey registration.
I consent to the charge
I do not consent to the charge and understand my registration will not be accepted.
Refunds are not permitted unless registration numbers are insufficient. Credit card charges will be processed within
a week. Click "SUBMIT" below to finalize your registration.
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