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Enter today's date (mmm-dd-yy)
* required
Name of Person Submitting the Team(Team Rep) (first name, last name)
* required
Team Rep's email address:
* required
Team Rep's Street Address
* required
City
* required
Postal Code
Team Rep's Telephone
* required
I wish to enter a team at the level indicated below (enter the level played during the 2017-8 season)
Novice REP
Atom REP
Peewee REP
Bantam REP
Midget REP
Team Name
* required
TEAM COLOURS - subject to availability
- TEAMS MUST SUPPLY THEIR OWN JERSEYS.- don't purchase until
colour availability is confirmed - first entries get best choice - the League has limited sets available to rent at $100.00
for the season.
TEAM ROSTER: I understand that I must complete and submit a team roster including player and parent/guardian signatures
prior to the first game. Only players on the roster may play.
I accept the roster terms above
I do not accept the roster terms above and understand my registation will not be accepted.
PLAYER HEALTH CERTIFICATION: My acceptance selection certifies
that the players are in good normal health, are properly equipped (full hockey equipment mandatory)
and have no abnormal handicaps. My acceptance selection also confirms I have the
authority to complete this application on behalf of the players named on the roster I have agreed to submit. Registration
is conditional on accepting these terms by checking the appropriate box below.
Yes - I accept and have obtained the authority to accept these terms on behalf of the players.
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 any child of the team (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 and also my authority to
allow all members of the team 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 any
members of the team (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 am the Team Rep and have obtained the permission
of all Parents/Guardians of the players on the team to assume the conditions above on behalf of the team members. My
acceptance also indicates that I have thoroughly read and agree to all of the terms above. Registration is conditional on
accepting these terms.
Yes - I accept and have obtained the authority to accept these terms on behalf of the players.
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 that I have obtained
confirmation of acceptance of these terms 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 accept and have obtained the authority to accept these terms on behalf of the players.
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 $2890.00 (including$322.48HST) 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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