NEW SAMHA/Raiders/Rep Registration Package This package consists of all forms needed to register for SAMHA, SAMHA Rep and Raiders. This package is for NEW players who currently reside within SAMHA residential boundaries. Please only fill out the forms that are applicable to your child. Please see below for applicable forms needed. SAMHA: SAMHA Registration Form PIPA HA Parent Declaration Form (you must provide proof of residency) SAMHA REP: SAMHA Registration Form PIPA SAMHA Rep Team Agreement Form HA Parent Declaration Form (you must provide a proof of residency) RAIDERS: SAMHA Registration Form PIPA Raiders Club Team Agreement Form HA Parent Declaration Form (you must provide a proof of residency) Once you have completed these forms either mail them to PO Box #47, St. Albert, AB T8N 1N2 or drop them off at the SAMHA office located in front between the Akinsdale and Kinex Arena - 66 Hebert Road, St. Albert or scan and upload to your child s profile on the RAMP registration site accessed through the SAMHA website.*** along with a copy of your child s birth certificate and proof of residency (a current utility bill, Driver s licenses will not be accepted)*** ALL SKATE TIMES AND LOCATIONS WILL BE POSTED ON THE SAMHA/RAIDERS WEBSITE www.samha.ca or www.raidershockey.ca NO PHONE CALLS WILL BE MADE. Please find the current office hours posted on the website at www.samha.ca The SAMHA office is closed Weekends and Holidays. If you have any questions, please do not hesitate to contact the office at 780-459-4052. Email addresses, registration fees and other useful information can be found on our websites www.samha.ca or www.raidershockey.ca (Revised April 2013)
ST. ALBERT MINOR HOCKEY ASSOCIATION PO BOX 47, St. Albert, Alberta T8N 1N2 PHONE (780) 459-4052 FAX (780) 459-4996 www.samha.ca Initiation 1 (2009-2010) $300.00 Initiation 2 (2008) $450.00 Novice (2006-2007) $585.00 Atom (2004-2005) $635.00 Peewee (2002-2003) $685.00 Bantam (2000-2001) $685.00 Midget (1997-1999) $685.00 **Please note these fees do not include tryout or late fees, for a full list of registration fees, please see the website ** Player s Name: Player s Address: City: Postal Code: Home Phone: 2014-2015 Season Date of Birth: (yyyy-mm-dd) Email Address: Position: Shoots: R L Last Year s Team: Club/REP Tryouts: Y N Import/Non Resident Y N Gender: M F If you are a female player will you be playing: Coed Female only Mother s Name Address: City: Postal Code: Cell Phone: Home Phone: Work Phone: Father s Name Address: City: Postal Code: Cell Phone: Home Phone: Work Phone: Emergency Contact Name: Phone: Parent/Guardian s Name (print): Parent/Guardian s Signature: Player s Name (print): (only if over 18 yrs old) Player s Signature: Date: For Office Use Only Date: Registration Requirements PIPA PV Form PTT Form Release Birth Certificate NTTO Rep/Club Form Parent Decl. D/L Utility Bill Reg Form Player Movement Other Fee Description Amount Date Payment Amt Method Registration Fee 1 Late Fee 2 Try Out Fee C R 3 Other 4 Notes: Receipt # Conditions Hockey Alberta and its Local Minor Hockey Associations (LMHA) recognize and agrees to abide by Hockey Alberta and its LMHA and CHA constitution, their regulations, their playing rules and all duly approved amendments thereto. Every member recognizes Hockey Alberta and its LMHA as being the sole organization entrusted with the management and organization of hockey throughout the territory of Hockey Alberta and its LMHA. Every Hockey Alberta and LMHA member recognizes that all information provided herein is true and valid. Any false information provided herein may lead to the application of sanctions as provided in various regulations. All registrations are subject to review by the Registrar and no registration will be approved until all fees are paid and required documentation is received. Registration is undertaken with the understanding that additional team fees and/or fundraising may be required depending on the level of play.
ST. ALBERT MINOR HOCKEY ASSOCIATION PERSONAL INFORMATION PROTECTION ACT NOTICE AND CONSENT PLAYER (print name) BIRTH DATE The Purpose of this notice and consent is to inform you of the use to which player information, pictures and game information and game statistics will be made and to obtain your consent for such use. 1. The player information is collected and maintained so as to properly coordinate and operate the St. Albert Minor Hockey program and is also provided to Hockey Alberta and Hockey Canada or any league the player's team plays in, for registration, recording statistical information and insurance purposes. 2. Player's names, information, data, photos and comments may also be used in team or league newsletters, annual reports, St. Albert Minor Hockey Association and Hockey Alberta web sites, radio, newspaper and other hockey or local publications. 3. Individual and team photos may be taken and displayed in the local newspaper and in local arenas and the offices of St. Albert Minor Hockey Association and yearbooks and other reports and advertisements prepared by St. Albert Minor Hockey Association. 4. Player's names and parents/guardians telephone, e-mail and other information may be used for the purposes of team, league and for St. Albert Minor Hockey Association communication and transportation matters and services. 5. Player's names may be included on lists for the purposes of team placement and for tracking player statistics by the team, leagues, St. Albert Minor Hockey Association, and Hockey Alberta and such statistics may be displayed on their websites. 6. This Consent shall remain in force for as long as the Player is a member of St. Albert Minor Hockey Association and need only be signed once. I hereby consent to the above: Signature of Parent/Guardian Date Parent/Guardian (print name)
PARENT DECLARATION FORM TO: The Local Minor Hockey Association (c/o Registrar) in which the Player will be registering. Dear Sir/Madam, I/We parent(s) of Player, (Player s) date of birth / / hereby declare that I/We have established our permanent (dd) (mm) (yyyy) residence at the following location: Address: (New Residence) Legal Land Description: City / Town: Postal Code: Phone: E-Mail: Mailing Address: (If Different from Above) We have resided at the above (new) address since: /. (mm) (yyyy) Our former address was: Address: City / Town: (Former Residence) Legal Land Description: Postal Code: Phone: E-Mail: Mailing Address: (If Different from Above) Yours truly, Date: / / Signature of Parent(s) (dd) (mm) (yyyy) Conditions: 1. Parent Declaration Form is the designated Hockey Alberta form used by Players whose parent(s) change residence in situations where the Player continues to reside with the parent. 2. A Player s residence shall be determined by reference to the residence of his or her parents/legal guardians (as defined in Hockey Canada Regulation F3). (See Hockey Alberta Regulation 6.2) 3. A Player may not register in another Local Minor Hockey Association that is of the same Category as or a lower Category than the Local Minor Hockey Association in which the Player resides. (See Hockey Alberta Regulation 3.6 exceptions apply.) 4. Hockey Alberta reserves the right to request proof of residency documentation in accordance with Hockey Canada Regulation F3 requirements. 5. Falsification of any information may result in discipline as per Hockey Canada / Hockey Alberta regulations. P:\Operations\MEMBER SERVICES\FORMS\Parent Declaration Form (NEW).doc
REP HOCKEY REQUIRMENTS (NO EXCEPTIONS) To All Parents: Being a member of a SAMHA s Representative Hockey team will place great demands on both a family s time and financial obligations. Before paying your REP tryout fee, please ensure that you can commit to the following if your child makes one of the Representative (REP) Hockey Teams: PROPOSED TEAM BUDGETS: Atom A/PeeWee A $1400/player Atom AA/PeeWee AA $1400/player EQUIPMENT: Navy Blue Gloves, Navy Blue Pants, and White Helmet are MANDATORY for Midget and Bantam Raider Club levels AND Strongly encouraged at the PeeWee and Atom REP levels. DRESS CODE: All REP team members must comply with the REP dress code. PRACTICES ARE NOT OPTIONAL Child s name: (please print) Level trying out for: (PeeWee or Atom) *********** I have read and understand the above Signature of Parent Date Print Parent s Name (Revised February 2008)
CLUB REQUIREMENTS (NO EXCEPTIONS) To All Parents PLEASE READ CAREFULLY: Being a member of a Raider s Hockey Club team will place great demands on both a family s time and financial obligations. Before paying your Club tryout fee, please ensure that you understand and are prepared to accept those obligations. Some of those obligations will include (but may not be limited to) the following: 1. Each year the Raider s Hockey Club hosts the John Reid Memorial Bantam AAA Hockey Tournament. This tournament is a fundraiser for the entire club with all teams and players receiving the benefit from funds raised. As a result, it is MANDATORY that ALL Club families contribute to this tournament as follows: a. Each FAMILY will be required to supply one person to volunteer to work a minimum of one volunteer shift PER CLUB PLAYER for the John Reid Memorial Bantam AAA Tournament (i.e. if you have one child playing for the club you must supply one person to work one shift; if you have two children playing for the club you must supply two people to work two shifts, etc.) b. Parents from each and every club team must participate in obtaining sponsors for the Tournament. Each team is responsible for supplying a MINIMUM of six (6) team sponsors totalling NOT LESS THAN $1,000.00. c. Each team is responsible for supplying additional parent volunteer(s) to serve as Team Representatives to work with the Tournament Committee during the tournament planning process. Failure by parents and teams to satisfy these requirements may result in penalties being assessed to the team by the St. Albert Raiders Hockey Club as determined by the Club upon consultation with the John Reid Memorial Tournament Committee. 2. Each player will be responsible for payment of a $100 Club fee if selected to a Club Team. 3. Each player will be responsible for payment of annual team fees as determined by each individual team. You can expect that you will be responsible for payment of fees based on the following estimate: POSSIBLE ANNUAL TEAM FEES PER PLAYER: Bantam AA Bantam AAA (M & F) Midget AA Midget AAA 15 Midget AAA (M & F) $5000-$6000 from each player (Please also note the following: Team fees are determined by each team at the beginning of the year based upon various factors as determined by the team coaches and manager(s). The amounts set out above are guidelines only and actual amounts assessed to players may be greater the amounts as noted. These fee estimates will increase due to Tournaments, Playoffs and Provincials. Players that are still on the Raiders MAAA male roster at the time of the camp will be required to pay an additional $300.00 for the Jasper conditioning camp. 4. REQUIRED EQUIPMENT: Navy Blue Gloves, Raiders Shells, and White Helmet are MANDATORY for all Club players. 5. DRESS CODE: All Club team members must comply with the Club dress code. Team jackets from approved suppliers only are MANDATORY. 6. Player s name/phone number/e-mail and other information may be used for the purposes of team, leagues, and for any SAMHA and Raiders communications which they deem appropriate, including transmittal to Junior Hockey Clubs, and transportation, all other matters and other services. 7. PRACTICES ARE NOT OPTIONAL The expected level of commitment from Raider s players is very high. Players must be aware of this expectation and be prepared to be suitably committed to their team. 8. RELEASES & REFUNDS: I agree that I am not entitled to a Release or a refund from the Raiders Hockey Club or St. Albert Minor Hockey Association of any funds that I might have paid to them until I have fully paid all of my Team fees and completed all of my Team obligations. I agree that all refunds shall be applied against any outstanding Team fees. Failure to pay Team fees as required will result in suspension from all team activities. I hereby acknowledge that I have fully read this document and I understand the stated obligations and expectations of my child as a Raiders Player and myself as a Raider s Parent. I hereby agree to all of the above. Player s name: (please print) Level trying out for: (Bantam or Midget) Signature of Parent Print Parent s Name Date {Client Files/9311/7/E1484228.DOC } (Revised February 2013)