Adult Player Registration & Waiver Form

Team Name: __________________________________________ Division: ______________ Jersey #: ___________

If you have not been drafted or appointed to a team, please leave blank.

Players Name: ___________________________________________________ Date of Birth: _____ / _____ / _______

Month Day Year

Address: ____________________________________________ City: __________________ Postal: ______________ Home Phone: _____________________________________ Business/Cell: ___________________________________ Email: _________________________________________ Player Position: C ____ R ____ " ____ ____ ! ____ D

WARNING: Please read this waiver arefully, by si!nin! this a!reement, you are affe tin! your le!al ri!hts and liabilities. "o not si!n this a!reement unless you have arefully read this entire a!reement, understand it, and a!ree with all of its ontents.
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF ALL RISKS AND INDEMNITY AGREEMENT # A"REE that # am o$er the a%e of &' years( and that #( the undersi%ned( a%ree that in )onsideration of myself *ein% +ermitted to enter and use any one of the des)ri*ed lands( *uildin%s( and +remises used for *all ho),ey( and for ANY a)ti$ities in)ludin%( *ut not -ust limited to( *all ho),ey( on *ehalf of myself( my heirs( su))essors and assi%nors( D. HEREBY REM#/E( RE!EA/E( #NDEMN#0Y( /A1E HARM!E//( D#/CHAR"E( AND 0.RE1ER H.!D HARM!E// Border City Ball Ho),ey 2BCBH3 #n)4( the 0C5 Centre( and the City of indsor( their dire)tors( em+loyees( $olunteers( )oa)hes( instru)tors( a%ents( and inde+endent )ontra)tors and their heirs( su))essors( and assi%nors from any )laims 6hatsoe$er arisin% *y reason of any disease( deterioration of health( illness or in-ury to any +erson( in)ludin% death( or for dama%e to( or loss of any of my +ro+erty resultin% from or arisin% from use of the lands and +remises( from *ein% +resent on the lands and +remises( from +arti)i+ation in any +ro%ram( from the use of any fa)ilities or e7ui+ment lo)ated on the lands and +remises( from a))e+tan)e of the ad$i)e of( or from the %ross or 6ill full ne%li%en)e of the City of indsor( the 0C5 Centre( Border City Ball Ho),ey #n)4( their dire)tors( em+loyees( $olunteers( )oa)hes( instru)tors( a%ents( inde+endent )ontra)tors or any other +ersons usin% the lands and +remises4 8he a)ti$ities that # 6ill *e +arti)i+atin% in 6ill *e inherently dan%erous( and # 6ill *e e9+osed to ris, of serious in-ury( disa*ility( death( and ris, of dama%e to or loss of +ro+erty4 # a),no6led%e that there may not *e +rom+t a))ess to medi)al assistan)e or treatment 6hen +arti)i+atin% in any a)ti$ities( and # assume and a))e+t any ris, relatin% to the a))ess to medi)al assistan)e and/or treatment4 By si%nin% this do)ument # a),no6led%e that # ha$e read( understood and a))e+ted the )onditions of this 6ai$er form as 6ell as the rules atta)hed as +ertains to the lea%ue and are 6ai$in% )ertain le%al ri%hts( in)ludin% the ri%ht to sue4 PRIVACY CONSENT #(_____________________________________________( do here*y )onsent to the )olle)tion and use of my +ersonal information 2in)ludin% first and last name and hometo6n3( +ersonal ima%es( athleti) results and a6ards( +ri:es re)ei$ed( and $er*al 7uotes( *y +ostin% on the 6e*site( or affiliated 6e*sites( of Border City Ball Ho),ey #n)4 or the City of indsor and/or *y +u*lishin% in the ne6sletters of BCBH4 # understand and a%ree that this information 6ill not *e sold to anyone 6ithout my +rior 6ritten )onsent4 # understand that my +ersonal information )an *e $ie6ed *y anyone 6ho a))esses Border City Ball Ho),eys 6e*sites or +u*li)ations( and that my )onsent )an *e 6ithdra6n at any time( u+on ade7uate +rior 6ritten noti)e4 # %i$e this )onsent $oluntarily and 6ith the understandin% that any of this information may *e used in ne6s+a+er or ma%a:ine stories( +osted on 6e*sites( and to $erify my identity and re%istration 6ith BCBH4

Dated: _____ / _____ / _____

#onth "ay $ear

____________________________________________________
Player%s &i!nature

Yo r si!nat re on t"is #orm $i%% serve as yo r o##i&ia% si!nin! o# t"is re%ease' Dated: _____ / _____ / _____
#onth "ay $ear

_____________________________________________________
'(') Representative &i!nature

.00#CE 5/E .N!Y CA/H: _______ Date form re)ei$ed: ____________________

Re)ei$ed *y: _____________________________

CH; <: _______ Date of system entry: ____________________ Entered *y: ________________ Roster ___ Add ____ Delete ___ RCP8<: ______