Parent / Guardian's Name (if applicable):
City / State:
Date of Birth:*
Camp and Program Selection
Multiple programs can be selected - ex Spring Training Camp and Spring Cross-Ice Program
2017 July Group Session (Enter Group Name):
2017 August J.U.M.P. Specialty Camp
Midget / Junior Prep
Junior A / University / Pro
2017 IP1 Station Nation
2017 Summer Training Camp
2017 Summer Cross-Ice (3 on 3)
Please complete the medical information section. This section must be filled out in its entirety for your registration to be accepted.
Primary Name on Insurance:
Medical Insurance Company:*
Allergies / Medical Conditions:
Release of Liability and Assumption of Risk Agreement
In consideration of me or my minor child/ward being allowed to participate in the CORE HOCKEY program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:
1. The risk of serious injury from the sports activities involved in this program is always presented due to the nature of the sport (s) and,
2. FOR MYSELF, SPOUSE, AND CHILD (CHILDREN), I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s (children’s) participation; and
3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s (children’s) participation. If, however, I observe any unusual significant concern in my child’s (children’s) readiness for participation and/or in the program itself, I will remove my child from participation and bring such to the attention of the nearest official immediately; and
4. I, for myself on behalf of my heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the CORE HOCKEY program, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for activity, WITH REPSECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, regarding my child (children) and/or arising from his/her activities, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASES OR OTHERWISE, except for willful misconduct, or otherwise to the fullest extent of the law.
5. I acknowledge and agree to photos being taken at CORE HOCKEY and that said photos may be used without notification for promotional purposes.
I have read the RELEASE OF LIABILITY and ASSUMPTION OF RISK AGREEMENT, fully understand their terms, understand that I have given up substantial rights by checking this box, and do so freely and voluntarily without any inducement.*
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Core Hockey, a Division of 2291349 Ontario, Inc.