Winter 2010 (Jan 3rd-Mar14th)
Spring 2010 (Mar 28th-June 13th)
Summer 2010 (June 27th-Sept
19th) Fall 2010 (Oct 3rd-Dec 19th)
Please register
for only one session per form. PLEASE PRINT CLEARLY. Payment is
due by the third week of league play.
If payment
is not received, you will not be able to play until payment is received. NSF
checks will carry a $25.00 fee.
Player Name: ___________________________________
Age: _________ Date of Birth: _____/_____/_____
Address:
Home Phone: ____________________ Cell Phone:
____________________ Work Phone: ____________________
Email:
____________________________________________________________________________________________
Parent/Guardian Name (under 18):
_______________________________________________________________
Parent Phone: ________________ Parent Alt phone:
________________ Parent Alt Phone: ________________
Choose your session-(Circle one)
Winter Spring Summer Fall
Parent Willing to Coach?
Yes______ No______
Player Willing to Goal Tend? Yes______ No______
Prices are based on all
games being played at Fast Forward Skate Center
5
Instructional
..........Saturday
5
10 and
under
..Sunday
5
12 and under
........Sunday
5
14 and
under
.Sunday 4:30pm-10:30pm
....$145(Includes Practices)
5
High
School
.Tuesday or Thursday
5
Adult Bronze
.
Monday
or Wednesday
5
Adult
Silver
.
Monday
PARTICIPATION
AGREEMENT, PLAYER RELEASE AND ACKNOWLEDGMENT OF RISK
In consideration of the
services of the Southern Wisconsin Inline Roller Hockey League, its agents,
officers, employees, and all other persons or entities acting in any capacity
on its behalf (hereinafter referred to as SWIRHL), I hereby agree to release
and discharge SWIRHL, on behalf of myself, my heirs, assigns, personal representatives
and estate as follows:
1.
I agree to follow the rules, as set forth by SWIRHL, and obey the
rink referee and/or supervisor at all times. An official rule book has been
provided to me and I agree to fully read it, understand it and abide by it.
2.
I understand the importance of using the protective equipment
specified in the SWIRHL rules and agree to the use of Helmets, Gloves, Shin
guards, elbow pads, Inline skates and stick specifically designed for hockey. I
also understand that a full face mask and mouth guard are required for players
under the age of 18 and strongly recommended for adults
3.
I understand that there are inherent and other risks involved in
the sport of roller hockey. Injuries are a common and ordinary occurrence in
this sport and I freely assume the risks.
4.
I agree that I will not play roller hockey under the influence of
drugs and alcohol
5.
I expressively agree and promise to accept and assume all of the
risks in this activity. My participation is strictly voluntary and no one if
forcing me to participate and I elect to participate in spite of all risks.
6.
I hereby voluntarily release, forever discharge and agree to hold
SWIRHL harmless based on my prior knowledge of all risks assumed while
voluntarily participating in the sport of roller hockey. By signing this form
in acknowledge that if anyone is hurt or property damaged during my
participation in these activities, I will have no right to make a claim of file
a lawsuit against SWIRHL, its agents, owners, employees or any other persons or
entity acting in any capacity oh its behalf, even if they or any of them
negligently caused such injury of damage.
Players Name_________________________ Players
Signature__________________________ Date_____________
Parents Name_________________________ Parents
Signature_________________________ Date_____________
*Players division placement is based upon
their age as of January 1st of the current session year.
The Southern Wisconsin Inline Roller Hockey
League reserves the right to move a team or player to proper division if
team/player skill level exceeds those divisions parameters. Teams will be
given an option of moving up 1 division or splitting into 2 separate teams if
skill level is above expectations.
*You may print out this Form, Mail, E-mail or bring to
This
is not a school sponsored activity and the