PLAYER REGISTRATION FORM Name: (Last

PLAYER REGISTRATION FORM
Name:
___________________________________________________________________________________
(Last Name)
(Middle
Initial)
(First
Name)
Address:
___________________________________________________________________________________
(Street)
(City)
Birth:
____/____/____
DD
MM
(Postal
Code)
YR
Player Telephone:
Residence # _____________________________
Cell#
____________________________
Player Email Address:
_________________________________________________________________
Parent(s) or Guardian name(s) (UNDER 18):____________________________________________
Parent email:
__________________________
Parent Telephone:
___________________________
Health Card #
___________________________
Position 1st
Pref: ___________
2nd
Pref: ____________
Team Played With Last:
Year:________________________________________________________________
Height: ________
Weight:
_________
Shot: Left
Do you work: No
____
____
yes:
Yes
If
Full-­­time
____
Part-­­time _____
School:
________________________________________
Grade Entering This Year:
____________
______ Right ______
RELEASE AND WAIVER:
In consideration of acceptance of this registration in the Cochrane Crunch Training
Camp, I, for myself, my heirs, executors, administrators and assigns, release the
Cochrane Crunch and its respective servants, agents or employees and all organizers,
sponsors, representatives, of the Cochrane Crunch Training Camp and any other
person or organization assisting in this event from any and all claims, demands,
damages, actions or causes of actions arising out of or in consequence of any loss,
injury or damage to my person or property incurred while attending at or
participating in a training camp notwithstanding any such loss, injury or damage
that may have arisen by reason of the negligence of the Cochrane Crunch team or
any other party above-­­mentioned. Without limiting the generality of the foregoing,
I further release any recourse, which I may now or hereafter have resulting from any
decision of the Cochrane Crunch team. I further state that the registrant is in proper
condition to participate in this event and I am aware that participation could in some
circumstances, result in physical injury. The registrant is attending this training
camp of his own free will and has obtained permission, from the physician of choice
to participate in the training camp. Permission for the free use of the registrant’s
name and picture in broadcasts, telecasts or written accounts of the events is hereby
granted. Full particulars of any physical condition which may affect the registrant’s
health, ability or performance has been disclosed in writing to the organizers of this
event.
____________________________________
___________________________________________
Signature of Registrant
Signature of Parent or Guardian
(if 18 years of age or under)
Date
_______________________________
INDEMNIFICATION
In consideration of the Cochrane Crunch team accepting the written registration,
I hereby agree to indemnity the Cochrane Crunch team its servants, agents and
employees and all organizers, sponsors, representatives of the Cochrane Crunch
team arising out of or in consequence of the attendance or participation of by the
above named registrant in the Cochrane Crunch Training Camp.
____________________________________
___________________________________________
Signature of Registrant
Signature of Parent or Guardian
(If 18 years of age or under)
Date: _______________________________
Please Email your Application to: [email protected]
Contacts: Ryan Leonard Phone #: (705) 257-0132