Thank You, Upper Moreland Ice Hockey Club

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1 The Upper Moreland Ice Hockey Club (UMIHC) is pleased to announce registration for the Fall/Winter Season is open. Please your registration to Checks can be mailed to Scott Helsinger at 2345 Pioneer Road, Hatboro Pa or you can the club to make other arrangements. Checks should be made payable to Upper Moreland Ice Hockey Club (same for Lower Moreland Middle School) Please note: In order to play with the UMIHC, players must attend 1) an Upper Moreland District School, (middle school- attend Upper or Lower Moreland) or 2) be home schooled within the district. This is a Suburban High School Hockey League (SHSHL) requirement. Some players may be eligible if they attend a private school and live in the Upper/Lower Moreland School District but for Middle School team only. All players/parents must provide the following: 1. Financial Responsibility Form with the appropriate registration fee* Fall/Winter Registration Form 3. Copy of USA Hockey/AAHA Internet Registration. Must be included with registration. See Instructions 4. Player Movement Risk Acknowledgment and Liability Waiver 5. Jersey Information (As Needed) 6. USA Hockey Waiver of Liability Form 7. USA Hockey Consent to Treat Form 8. Physical Information 9. USA Hockey Code of Conduct 10. Parent and Player Codes of Conduct. (signed by parents and player) 11. Web Site Release 12. Copy of Birth Certificate for new Players ONLY Please view the fees schedule on the next few pages. Registration fees are non-refundable unless UMIHC does not have enough players to field a team. Thank You, Upper Moreland Ice Hockey Club Upper Moreland Ice Hockey Club Questions - please us at umbearshockey@gmail.com Middle School High School Varsity Team 5/12/2017 1

2 Financial Responsibility Form 2017/18 JV/Varsity or Middle School Please check one As Parent(s) / Guardians(s) of, I / (We) agree to be financially responsible for all Player Fees associated with the Upper Moreland Ice Hockey Club ( UMIHC ) program for the Season for the aforenoted player. Player Fees may include player tryout, registration and program fees as indicated on the following schedule. Additionally, Player Fees may include costs accessed for damage to facilities, locker rooms, etc., used in connection with UMIHC practices, games or other UMIHC or team events which are caused by, or in part by the aforenoted player. I / (We) also agree to full financial responsibility even in the event that playing or participation privileges are suspended and/or terminated due to academic, injury or disciplinary matters. I / (We) further acknowledge that according to the by-laws of the UMIHC that a player who resigns or otherwise voluntarily terminates his or her participation is not entitled to any refund or credit for amounts paid or due the UMIHC. The Player Fees and payment structure for the season is as follows: Non-Refundable Deposit $50 (Payable at Registration, not later than 5/24/2016) Second Installment August 30, 2017 $ 150 Third Installment September 30, 2017 $ 150 Fourth Installment October 30, 2017 $ 150 TOTAL (Less USA Hockey and AAHA registration) $ 500 If paid in full by June 15 the yearly fee will be $450 Players and coaches are required to register with USA Hockey (USAH) and Atlantic Amateur Hockey Association (AAHA). The registration confirmation (bar code sheet) must be submitted after May 1 and before Sept 15th. Registration for both can be accomplished at See detailed instructions on page 4. Any player not paid or in good standing by the installment due date will not be permitted on the ice for any further practices or games. (We) understand the nature of the Player Fees and agree to be financially responsible. Parent / Guardian Date Parent / Guardian Date **The total season fee is an estimate and is dependent upon registration and is subject to change. 5/12/2017 2

3 Fall/Winter Registration Form Player Name: Age: DOB: Address: Phone #: Best address for player: Grade ( ): School: Height Weight POSITION: forward defense goalie Jersey #: EXPERIENCE: BE SPECIFIC AND CIRCLE THE APPLICABLE CHOICE Travel or Club Hockey Tier: AAA AA A B (Do not use School levels) Highest Level: Midget Bantam Peewee Squirt Mite (include Fall 2017 team # of years previously played: for Tier and Level only) School Hockey- winter only Highest Level: Varsity JVAA JVA JVB MSA MSB (Do not use Spring levels) # of years previously played: In-House- winter only Highest Level: Midget Bantam Peewee Squirt Mite (Do not use Spring levels) # of years previously played: **All players must be registered with USA Hockey/AAHA. Please attach a copy of your confirmation number with this registration form. If you are registered with a travel team, use the same confirmation number. Do not register twice. (see pg 4 for further USA Hockey info.) Mother s name: Phone #: Address if different: Cell Phone #: 5/12/2017 3

4 Mother s Address: Father s name: Phone #: Address if different: Cell Phone #: Father s address: Release of liability, Acknowledgement of Risk: Upon entering events sponsored by UMIHC and/or its member districts, I/we agree to abide by the rules of the UMIHC as currently published. I/we understand and appreciate that participation or observation of the sport constitutes a risk to me/us of serious injury, including permanent paralysis or death. I/we voluntarily and knowingly recognize, accept and assume this risk, and release UMIHC and its officials from any liability. Participant s Signature: Parent/Guardian Name (Print): Parent/Guardian Signature: 5/12/2017 4

5 Instructions for registering on-line with USA Hockey/AAHA For the season you will need to register on-line with USA Hockey/AAHA: 1. Registration for the seasons begins May 1, Go to 3. Go to the player tab and choose Register on line from the drop down menu. Under "Chose Member Type" click on the Ice Players & Coaches button. Then follow the instructions. 4. You will need a credit card to complete the registration. The credit cards that can be used are Visa, MasterCard, American Express, and Discover. 5. The fee is $40.00 for USA Hockey and $10.00 for AAHA (local affiliate) for a total of $ When you complete the registration print 2 copies of the confirmation form. Keep one and attach a copy of the confirmation page to the registration packet. It is also suggested that you save the confirmation form to your hard drive should you need it later. 7. If you are previously registered with another club (travel) for the season you will use the same confirmation page that you gave to your travel team. Do not register twice or you will have paid double and no refunds will be made. NOTE: FAILURE TO REGISTER WITH USA HOCKEY WILL RESULT IN THE PLAYER NOT BEING ROSTERED AND HE/SHE WILL NOT BE ALLOWED TO PLAY WITH THE TEAM. 5/12/2017 5

6 JERSEY INFORMATION Player Name: JERSEY INFORMATION All Varsity players are required to have 2 Jerseys, 1 home and 1 away. Two pairs of socks (one dark pair and one light pair). Team shells are required for Varsity players. Jersey Size-Adult only (circle one): M LG XLG _ XXLG Goalie cut Jersey Number: All new players must select 3 choices for Jersey Numbers. Numbers will be assigned on a first come first serve basis. Selections: Please note: Jersey Numbers are assigned to one player and may not be transferred to a sibling without prior approval from the board. Additional items will be available for order at Registration. Should you have any questions regarding sizing or ordering, please contact the UMIHC All players are not required to wear Upper Moreland logo apparel to the games and tournaments. If you would like a hockey sweatshirt please indicate the appropriate size below and we will provide the cost to you. Adult only (circle one): M LG XLG XXLG 5/12/2017 6

7 USA Hockey Waiver of Liability, Release Assumption of Risk & Indemnity Agreement It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releasees. Releasees include USA Hockey, Inc., its affiliate associations, local associations, member teams, event hosts, other participants, coaches, officials, sponsors, advertisers, and each of them, their officers, directors, agents and employees. For and in consideration of the undersigned participant s registration with USA Hockey, Inc., its affiliates, local associations and member teams (all referred to together as USAH) and being allowed to participate in USAH events and member team activities, participant (and the parent(s) or legal guardian(s) of participant, if applicable) waive, release and relinquish any and all claims for liability and cause(s) of action, including for personal injury, property damage or wrongful death occurring to participant, arising out of participation in USAH events, member team activities, the sport of ice hockey, and/or activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant (and participant s parent(s) or legal guardian(s), if applicable) may have are hereby waived, released and relinquished, and participant (and parent(s)/guardian(s), if applicable) does(do) so on behalf of my/our and participant s heirs, executors, administrators and assigns. Participant (and participant s parent(s)/guardian(s), if applicable) acknowledge, understand and assume all risks relating to ice hockey and any member team activities, and understand that ice hockey and member team activities involve risks to participant s person including bodily injury, partial or total disability, paralysis and death, and damages which may arise there from and that I/we have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the releasees identified below. These risks and dangers include, but are not limited to, those arising from participating with bigger, faster and stronger participants, and these risks and dangers will increase if participant participates in ice hockey and member team activities in an age group above that which participant would normally participate in. I/We further acknowledge that there may be risks and dangers not known to us or not reasonably foreseeable at this time. Participant (and participant s parent(s)/guardian(s), if applicable) acknowledge, understand and agree that all of the risks and dangers described throughout this agreement, including those caused by the negligence of participant and/or others, are included within the waiver, release and relinquishment described in the preceding paragraph. I/We agree to abide by and be bound under the rules of USA Hockey, including the By-Laws of the corporation and the arbitration clause provisions, as currently published. Copies are available to USA Hockey members upon written request. Participant (and participant s parent(s)/guardian(s), if applicable) acknowledge, understand and assume the risks, if any, arising from the conditions and use of ice hockey rinks and related premises and acknowledge and understand that included within the scope of this waiver and release is any cause of action (including any cause of action based on negligence) arising from the performance, or failure to perform, maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said rinks, for negligent selection of certain releasees, or negligent supervision or instruction by releasees. If the law in any controlling jurisdiction renders any part of this agreement unenforceable, the remainder of this agreement shall nevertheless remain enforceable to the full extent, if any, allowed by controlling law. This agreement affects your legal rights, and you may wish to consult an attorney concerning this agreement. Participant (and participant s parent(s)/guardian(s), if applicable) agree if any claim for participant s personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever or wherever made or presented for participant s personal injuries, property damage or wrongful death. Participant (and participant s parent(s)/guardian(s), if applicable) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers of ice hockey and understand these waivers and releases are necessary to allow amateur ice hockey to exist in its present form. Significant exclusions may apply to USA Hockey s insurance policies, which could affect any coverage. For example, there is no liability coverage for claims of one player against another player. Read your brochure carefully and, if you have any questions, contact USA Hockey or a District Risk Manager. Age Date Signed PARTICIPANT SIGNATURE PARTICIPANT NAME (PRINT) PARENT OR GUARDIAN SIGNATURE (if Participant is 17 years of age or younger) Date Signed 5/12/2017 7

8 USA HOCKEY CONSENT TO TREAT This is to certify that on this date, I, as parent or guardian of, give my consent to USA Hockey and its medical representative to obtain medical care from any licensed physician, hospital, or clinic for the above mentioned athlete, for any injury that could arise from participation in USA Hockey sanctioned events. If said athlete is covered by any insurance company, please complete the following: Name of Insurance Company: Address: Policy Number: Signed: (parent/guardian) Relationship to Athlete: Home Address: Phone: ( ) Date: Excess accident insurance up to $25,000, subject to deductibles, exclusions and certain limitations, is provided to all USA Hockey registered team participants. For further details call Lisa Flores, Talbot Agency, Inc., (505) To file an excess accident claim, call AIG, (800) C Rev 8/02 5/12/2017 8

9 Report of Physical Information Required to be filled out by parent Name: Date: Address: Birth Date: Daytime Phone: Evening Phone: WHO TO CONTACT IN CASE OF AN EMERGENCY? Name: Relationship: Daytime Phone: Evening Phone: Hospital of Choice: PLEASE COMPLETE THE FOLLOWING: If the answer to any of the following questions is or was yes, please describe the problem and its implications for proper first aid treatment on a separate piece of paper. Have you had (or do you presently have) any of the following? Circle One Head injury (concussion, skull fracture) Yes No Fainting spells Yes No Convulsions/epilepsy Yes No Neck or back injury Yes No Asthma Yes No High blood pressure Yes No Kidney problems Yes No Hernia Yes No Diabetes Yes No Heart murmur Yes No Allergies Yes No Please specify: Injuries to: Shoulder Yes No Knee Yes No Ankle Yes No Fingers Yes No Arm Yes No Other: Impaired vision Yes No Impaired hearing Yes No Other: Physical (continued) Medical History: (Give significant details, including allergies, operations, asthma, or any other physical restriction for the patient.) 5/12/2017 9

10 WHAT OTHER RECOMMENDATIONS DO YOU WISH TO MAKE TO THE COACHES WHICH MIGHT BE OF BENEFIT TO THIS CHILD FROM THE POINT OF PHYSICAL FITNESS: HEIGHT: WEIGHT: When was the patient s last Tetanus Booster? Is the patient currently taking any medications? What? Why? Are there any restrictions on this patient s activities? Explain: Name of Primary Physician: Date: Phone # of Physician: Address of Physician Parent s Name: Parent s Signature: 5/12/

11 PARTICIPANT CODE OF CONDUCT NAME: To be read and signed by you as a member of Team: Participating in USA Hockey for the season. 1. No swearing or abusive language on the bench, in the rink, or at any team function. 2. No lashing out at any official no matter what the call is. The coaching staff will handle all matters pertaining to officiating. 3. Anyone who receives a penalty will skate directly to the penalty box. 4. Fighting will not be tolerated. Fighting will result in an appearance before a Discipline Committee. 5. There will be no drinking, smoking, chewing of tobacco or use of illegal substance at any team function. 6. I will conduct myself in a befitting manner at all facilities (ice rink, hotel, restaurant, etc.) during all team functions. 7. Any player or team official who cannot abide by these rules or violates them will be subject to further disciplinary action. Signed: Date: Player name 5/12/

12 Upper Moreland Ice Hockey Club Parent/Guardian Code of Conduct All parents/guardians (referred to going forward as parents ) will abide by a Code of Conduct, which includes the following provisions: 1. Parents will be supportive of the UMIHC Player Code of Conduct, as well as the rules and regulations of USA Hockey and SHSHL. This includes: PARENTS WILL NOT GO ONTO THE ICE SURFACE AT ANY TIME UNLESS ASKED TO DO SO BY A GAME OFFICIAL/COACH IN THE CASE OF PLAYER INJURY. 2. Parents will help coaches emphasize that winning is the result of teamwork, practice, hard work and discipline. 3. Parents will not use loud, obscene or disrespectful language or gestures to coaches, players, game officials, opposing teams or spectators. 4. Parents will support the work and efforts of the Coaching Staff. Disagreements or disputes with the coaching staff should be addressed in a professional and respectful manor taking into consideration the 24 hour rule. The Coach also has the right to utilize the 24 hour rule. * If after direct discussions with the Coaching Staff, a parent believes that issues have not been resolved; concerns should then be directed to the Hockey Operations Director. If a parent believes that the issue has still not been resolved, the dispute will be referred to the Grievance Committee which consists of the Club President, Vice President and Hockey Operations The Hockey Operations Director is responsible for disciplinary action relating to the UMIHC Code of Conduct for Players, Parents and Coaches. 5. Parents will accept the decisions of referees and league officials as being fair and impartial. 6. Parents will ensure that their Player has and utilizes full and well-maintained protective gear. Players will not participate in games or practices without complete gear. 7. Parents will support the UMIHC rule that out of school suspensions result in game/practice suspensions on a one for one basis. The second suspension will result in a review, by the Board, of the Player s continued membership in the UMIHC. 8. Parents are financially responsible for the destruction, defacement or loss of use of property, at any rink or facility used by the UMIHC, caused by their Player. 9. Parents will not use or possess alcoholic beverages or non-prescription drugs at any UMIHC game, practice or facility. 10. Parents will make every effort to pay fees on a timely basis. If fees are not current with the schedule, the player will not be allowed to practice or play in any games. It is fully understood by UMIHC that any family can face unexpected financial problems. If issues arise that will delay your payment, please contact the Treasurer and every effort will be made to work out a solution. All conversations will be held in strict confidence. YOUR PLAYER WILL BE PLACED ON THE NO PAY/ NO PLAY LIST IF NOT PAID accordingly. 11. Serious violations of this code of conduct by parents may result in a temporary or permanent ban of the parent from the rink area during practice and game times. A decision to take this action must be approved by both the Hockey Operations and the President. *24 Hour Rule- refrain from speaking to Coach/Parent for one day so emotions can calm By signing below, I acknowledge my understanding of the above codes of conduct and my intention of being held to these standards as outlined in this document. Parent signature Parent signature Date Date Player Name: 5/12/

13 Upper Moreland Ice Hockey Club Player Code of Conduct THE READING AND SIGNING OF THIS DOCUMENT WILL BE CONSIDERED THE PLAYER S WARNING. All Players will abide by a Code of Conduct, which includes the following provisions: 1. Players will support and follow the UMIHC Code of Conduct as well as the rules and regulations of USA Hockey and SHSHL. 2. Academics always come first-----it is your future. JV and Varsity players will be held to the same grade standards as all JV and Varsity players at Upper Moreland High School. An F in any subject will result in your suspension from practice and games until a passing grade has been obtained. 3. Players will not use loud, obscene or disrespectful language or gestures to coaches, game officials, opposing teams, spectators or teammates. Excessive celebration, taunting or embarrassing opposing players is prohibited. 4. Initiating or participating in physical or verbal confrontations of any kind, whether during games, practices or off ice, with coaches, teammates, game officials, opposing players or spectators is prohibited. 5. Players will accept the decision of referees and league officials as being fair and impartial. 6. Players must act in a professional, truthful manner demonstrating respect and good sportsmanship. 7. Players will not use or be in possession of alcohol, tobacco, marijuana, or illegal or non-prescribed drugs at any time. 8. Stealing, destroying or defacing of any property or equipment owned, utilized or associated with the UMIHC will result in a review, by the Board, of the Player s continued membership in the UMIHC. 9. Out of school suspensions will result in game/practice suspensions on a one for one basis. The second suspension will result in a review, by the Board, of the Player s continued membership in the UMIHC. 10. Players must: a) Attend all practices and games if unable due to illness, injury or another commitment the player must provide prior notice to the Head Coach b) Be dressed and ready to take the ice 10 minutes before the game/practice. This time will be the Coaches time players being quiet and attentive so that the Coaching Staff can discuss the game or practice. c) Follow all coaching assignments, instruction, and discipline during practice and games (this includes pre and post game meeting/discussions). d) During a game there is no arguing or debating game strategy or coaches decisions on the bench. e) Take practice seriously help and support teammates. f) Wear full protective, well maintained, and ice hockey approved equipment, at all times, including a mouthpiece. Complete equipment is required in order to participate in games or practices. g) In order to play in a game, wear the team uniform, with black pants, black helmet and matching socks. h) After a game, shake hands with all opposing players and referees. i) Leave the locker rooms neat, undamaged, with no trash or tape left behind. 11. Player must not: a) Spit anywhere in the rink floors, walls, etc. b) Show disrespect for Coaches or Teammates. c) Toss sticks behind the bench area rather place in an organized fashion. d) Throw any equipment or objects out of anger at any time. e) Wear game jersey to practice. 5/12/

14 DISCIPLINARY ACTION FOR VIOLATIONS OF ANY OF THESE CODES The UMIHC Commissioner will notify all players of any infractions. The Disciplinary Committee, Board of Directors, and the Coaches will also be notified. By signing below, I acknowledge my understanding of the codes of conduct and my intention of being held to these standards as outlined in this document. As a general rule this code of conduct will be enforced in the order as outlined below. Based on the severity of the infraction and/or the attitude of the player, this process may be lessoned or accelerated with the President s approval. 1 st offense against any part of this Code of Conduct will result in an automatic game suspension and/or practice suspension. 2 nd offense against any part of this Code of Conduct will result in immediate suspension from all games and practices until review by the Board of Directors. For the 1 st offense of items 4, 7, or 8 of this Code of Conduct there will be an immediate suspension from all club activities until review by the Board of Directors. Expulsion from the Upper Moreland School District will result in immediate suspension from all practices and games and reinstatement to the team will be subject to the player s readmission to the Upper Moreland School District and approval by the Board of Directors. Player s Signature Parent s Signature Parent s Signature Date Date Date 5/12/

15 The Upper Moreland Ice Hockey Club has a webpage where club information will be posted. We will be listing team members, and would like to occasionally post pictures of the players and teams. Please fill out this form to indicate your preference on having information about your child posted on the team webpage. Web Page Permission Slip Please fill out one form per child and check all that apply: My Child's Name (please print clearly) My child s full name may be published on the web. My child s picture and first name may be published on the web. My child s picture if part of a group photo may be published on the web. My child s picture may be published on the web only if it does NOT list his/her name. Please do not publish my child's picture (individual or group photo) on the web. Please do not publish my child's name on the web. Parents names (Print): Parents Signatures: Date: Date: 5/12/