John Paul Medeiros Jr.

Memorial Inline Hockey Open Mens League Registration Form

Please PRINT your information below to register for the JP Medeiros Memorial Inline Hockey League. Your personal information will not be shared with or sold to third parties. Name: ____________________________________________________________ Date of Birth: ______________________________________________________ Player Preference: Individual (assigned to a team) Team (indicate team name): _______________________

Email: ____________________________________________________________ Cell/Phone: ________________________________________________________ Games are tentatively scheduled to begin July 12th and continue through August 30th on Monday and Thursday nights from 5:30 to 7:30. Schedule to be announced once all players have registered. Please submit by July 1, 2012. In the event of inclement weather, you will be notified of schedule changes via Facebook @ JP Memorial Inline Hockey. $100 team deposit due before season start. Remaining team fees of $300 are due in full by Game 2.
All participants are required to assume all risk by signing this general release. I understand that the risks I assume by participating in the John Paul Medeiros Jr. Memorial Inline Hockey League include, but are not limited to serious head and other bodily injuries. In consideration of receiving permission to participate in the Hockey League, I hereby release the Town of Warren, Clean Up Warren, and all its officers and employees from all liability for any personal injury, death or damage of any kind of arising from or related to my participation in the Hockey League. My decision to participate in the Hockey League is voluntarily assuming all risk or loss. Damage or injury including death, may occur through my participation in the Hockey League. I understand that by signing this release and waiver, I am giving up the right for myself and/or my family or heirs to sue the Hockey League, and its officers and employees for injuries resulting from participation in the Hockey League. I agree to abide by all RULES and REGULATIONS governing the Hockey League which includes any disciplinary measures, fines or suspensions levied by the Hockey League Officers. I understand that the league has a zero tolerance for fighting and further understand that if I should engage in a physical altercation, I will be immediately suspended for the remainder of the league. I also understand that there are no refunds.

Signature: ___________________________________________________

Warren Athletics LLC