Hazelton Minor Hockey Association Registration

Transcription

1 Hazelton Minor Hockey Aociation Regitration Regitration mut be PAID IN FULL by September 22"**, 2014 (or at the dicretion of HMHA hould minimum diviion number not be met) Plavcr Lat Name Firt Name Initial Mailing Addre Street Addre Citv Potal Code Home Phone # Birthdate (month/day/year) limail Gender (circle one) M F Mother/Ciuardian Name Work Phone # Cell Phone # Home Phone # hather/guardian Name Work Phone # Cell Phone # Home Phone # Emergency Contact Name/Phone # Medical Card # REGISTRATION FEES Pay i for PRACTICE dme only, not for tournament fee (CIRCLE AGE OF PLAYER on December 3r', 2013) Age on December 31*' 2013 Birth Year DIVISION FEE Initiation S250 REGISTRATION FEE WORKSHEET Equal Payment Plan - 3 pot-dated Cheque all dated prior to SEP 22, 2014 Family Dicount - muluple children from the ame parent() Oldet Child - 1"' child to be regitered, next i 2'"' oldet, next i 3"' oldet etc. MINUS: vice S350 Deduct $50-2'"' child regitration 9-It) y\tom $ Peewee S Peewee F FEMAT.F.ONLY Peewce FI-MALli Practicing both mixed and female $375 $ Bantam $375 Deikict 50% of regitration fee - 3^1 4''' child regitration LATb: RL-CilSTRATION FEE $50 if after Sept 22, 2014 Equal Payment Plan $250 Goalie Gear Rental Depoit TOTAL $ NO CASH PAYMENTS ACCEPTED % Midget $375 ooalie (fully geared w/ proper ize) All Diviion $200 Payable to Hazelton Minor Hockey Aociation (HMHA) HMHA BOX 421 New Hazelton, BC VP) 2)0 CHQ or MONEY ORDERS ONLY NO CASH PAVIVIENTS ADD $50 LATE REGISTRATION FEE (After Sept 22, 2014) NO CASH PAYMENTS ACCEPTED OFFICE USE ONLY # of Player other plyr_ other plyr_ i-ullpymt CHQ#_ M/0_ Date: CIIQ# M/O Date; CHQ # M/O Date: CHQ # M/O Date: Permiion: I hereby give permiion for theabove named chikl to take part in the Hazelton Minor Hockey Aociadon Program. 1will not hold the Hazelton Minor Hockey Aociation (HMHA), coache, referee, executive, or member legally reponible for any accident or injurie utained by the above named child while under the uper\ iion of HMHy\. I undertand that by enrolling my child in the HMHA, 1apply lo become a member of HMHA. I agree with my phone number and addre to be hared with HMHA, coache and team manager. Parent/Guardian Signature: Date:

2 HAZELTON MINOR HOCKEY ASSOCIATION PO BOX 421 NEW HAZELTON, BC VOJ 2J0 Welcome to HMHA' 2014/2015 Hockey Seaon. Viit our webite or our Facebook page Hazelton Minor Hockey Aociation. We alway need help with coaching, reffing, managing and organizing. Pleae contact HMHA Executive if you are intereted. Coache MUST have RESPECT IN SPORT and COACHING HYBRID. There are ubidie available for coache training through HMHA. Pleae read through the following information ENTIRELY before filling out your regitration application form: Pro-regitration form ignedat the end ofthe 2013/14 eaon were to acknowledge intentofplayerto regiterfor 2014/15 eaon. The following form till need to be filled out for the 2014/2015 eaon. Regitration fee mut be paid in advance. PLAYERS ARE NOT ALLOWED ON THE ICE UNTIL REGISTRATION and FULL PAYMENT IS RECEIVED and CLEARED through the bank. If a player' regitration i returned NSF, that player will be immediately upended from further play with HMHA until payment i made by money order including $50.00 NSF ervice fee. One regitration form to be ued for EACH player regitering. A ingle payment may be ued for multiple regitration form per family a long a each player' name i clearly indicated with the payment. Forthoe eeking financial aitance, pleae view the KidSport webite at Once financial aitance i received by HMHA, the peron who paid the player' regitration will be REIMBURSED from HMHA for the amount approved. Equipment i required for participation in all age categorie. Thi conit of: CSA approved Helmet Neck protector Chet protector with houlder pad Elbow pad Hockey pant Hockey jerey Hockey glove Athletic cup Shin pad Hockey ock Hockey kate Hockey tick If thi baic equipment i NOT worn by player, thee player will not be allowed on the ice until uitable. IF a player chooe to NOT wear any of the required equipment, upenion will be enforced. Any volunteer for HMHA MUST have RESPECT IN SPORT. All parent hould conider taking the Repect In Sport online coure - there i a cot (about $30) and it take about 2-3 hour to complete. Repect in Sport (RIS) Parent Program: The Repect in Sport Parent Program i an effective and informative online training program for parent of active children. Thi one hour online certification program reinforce a parent role in a child or youth' activitie, encouraging poitive port behaviour, and providing inight into the variou role other individual (uch a coache and official) play. Thi program empower parent to enure the afety of their children, encourage poitive and effective communication, and to enhance a child' fun and camaraderie ofthe activity. The number one reaon cited for coache, manager and official of all age leaving a port i unacceptable parent behaviour. Let the Repect in Sport Parent Program help aert proper parent behaviour to create a more rewarding, afe and repectful environment for all partie involved. Pleae viit BC Hockey webite for more information -

3 Hazelton Minor Hockey Aociation Parent/Player FAIR PLAY Contract PARENT CONTRACT It i the intention of thi CONTRACT to promote fair play and repect for all participant within the Aociation. All parent mut ign thi pledge before being allowed to participate in hockey and mut continue to oberve the principle of Fair Play. FAIR PLAY CODE I will not force my child to participate in hockey. I will remember that my child play hockey for hi or her enjoyment, not mine. I will encourage my child to play by the rule and to reolve conflictwithout reorting to hotility or violence. I will teach my child that doing one' bet i a important a winning o that my child will never feel defeated by the outcome of the game. Iwill make my child feel like a winner every time by offering praie for competing fairly and hard. I will never ridicule or yell at my child for making a mitake or loing a game. I will remember that children learn by example. Iwill applaud good play and performance by both my child' team and their opponent. Iwill never quetion the official'judgment or honety in public. I recognize official are being developed in the ame manner a player. I will upport all effort to remove verbal and phyical abue from children' hockey game. I will repect and how appreciation for the volunteer who give their time to hockey for my child. Iagree to abide by the principle of the FAIR PLAY CODE a et by Hockey Canada and upported by the Aociation. I alo agree to abide by the rule, regulation and deciion a et for the Hazelton MinorHockey Aociation. PARENT PRINT NAME DATE SIGNATURE(S); PARENT PARENT PLAYER CONTRACT It i the intention of thi contract to promote fair play and repect for all participant within the Aociation. All player mut ign thi contract tatingthat they will oberve the principle ofthe Fair Play Code before being allowed to participate in hockey. FAIR PLAY CODE I will play hockey becaue I want to. not becaue other or coache want me to. I will play by the rule of hockey and in the pirit of the Game. Iwill control my temper - fighting or "mouthing-off' can poil the activityof everyone. I will repect my opponent. I will do my bet to be a true team player. I will remember that winning in't everything - that having fun. improving kill, making friend and doing my bet are alo important. Iwill acknowledge all good play and performance - thoe of my team and my opponent. I will remember that coache and official are there to help me. I will accept their deciion and how them repect. Iagree to abide bythe principle ofthe FAIR PLAY CODE a et by Hockey Canada and upported by the Hazelton Minor Hockey Aociation. I alo agree to abide by the rule, regulation and deciiona et by the Hazelton Minor Hockey Aociation. PLAYER PRINT NAME DATE SIGNATURE: PLAYER _TEAM NO.

4 Hazelton Minor Hockey Aociation PRIVACY OF INFORMATION AND PHOTO CONSENT Member/Player (print name) Birthdate Hockey Canada ID # HMHA collect peronal informationfrom member, player, coache, referee, manager and volunteer in order to coordinate and operate HMHA program. By igning below, you indicate your conent to the ue of your peronal information a follow: 1. Member / player contact information i ued to facilitate Aociation, Diviion and Team communication. 2. Member/ Player information i hared with BC Hockey&Hockey Canada for the purpoe of regitration, tatitical record keeping and inurance purpoe. 3. Player' firt initial, lat name, and jerey number are diplayed on the HMHA webite to facilitate communication. Additional peronal information entered by the member in order to acce variou optional feature of the webite will be encrypted on the webite. 4. HMHA will pot player photo on it webite onlywhen given expre permiion to do o by a player' parent/guardian, or when it i not poible to identify individual player in the photo. 5. Player' name may be included in lit forthe purpoe ofteam placement and for tracking player tatitic by the team, league, HMHA, and BC Hockey, and thi information may be diplayed on their webite. Should you wih to withdraw conent at any timeto the ue of yourinformation for any purpoe, you may do o by contacting the Regitrar. I undertand that HMHA ha a Privacy of Information Policy outlined in it Handbook which can be obtainedfrom the Regitrar or at I conent to the ue of my peronal information a outlined above: Signature of Member/Parent/Guardian Member/Parent/Guardian(print name) Witne Signature Witne (print name) Date

5 HOCKEY CANADA d /V M /V PLAYER MEDICAL INFORMATION SHEET Name: Date of birth: Day Month Year Addre: Potal Code:.Telephone: Provincial Health Number: Mother' Name: BuineTelephone Number: Mother. Father' Name: Father. Peron to contact in cae of accident or emergency, if parent are not available. Name: Telephone: Addre: Doctor' Name: Dentit' Name: Telephone: Telephone: Pleae circle the appropriate repone below pertaining to you child Previou hitory of concuion Fainting epiode during exercie Epileptic Wear glae Are lene hatterproof? Wear contact lene Wear dental appliance Hearing problem Athma Trouble breathing during exercie Heart Condition Diabetic Ha had an illne lating more than a week in the pat year Medication Allergie HOCKEY CANADA SAFETY PROGRAM

6 C A N A 04V HOCKEY CANADA Wear a medic alert bracelet or necklace. Doe your child have any health problem that would interfere with participation on a hockey team? Surgery in the lat year. Ha been in hopital in the lat year. Ha had injurie requiring medical attention in the pat year. Preently injured. Pleae give detail below if you anwered "" to any of the above item. Medication: Allergie: Ue eparate heet if neceary Medical condition: Recent Injurie: Lat Tetanu Shot:. Any information not covered above:. Date of lat complete phyical examination: Any medical condition or injury problem hould be checked by your phyician before participating in a hockey program. I undertand that it i my reponibility to keep the team management advied of any change in the above information a oon a poible and that inthe event no one can be contacted, team management will take my child to hopital/m.d. if deemed neceary. I hereby authorizethe phyician and nuring taff to undertake examination invetigation and neceary treatment of my child, I alo authorize releae of information to appropriate people (coach, phyician) a deemed neceary. Date: Signature of Parent or Guardian: HOCKEY CANADA SAFETY PROGRAM