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IN-HOUSE
FALL 2008
EVALUATION SEPTEMBER 5th,6th,7th.
FALL 2008
PLEASE RETURN THIS INFORMATION SHEET
TO EASY STREET:
WITH THE FOLLOWING:
1.
PLAYER’S PAYMENT (MAKE CHECK PAYABLE TO “ICEOPLEX”
2.
SIGNED ICEOPLEX WAIVER FORM
3.
REGISTER at WWW.USAHOCKEY.COM for the INSURANCE
PLEASE PRINT CLEARLY
Players
Name_______________________________Parents name_________________________
Address
City St Zip
Home Phone
Wrk Phone Birthdate
E-Mail
POSITION PREFERENCE (check one):
 AGE CLASSIFICATIONS-
Goalie Defense Forward
Please check one:
[ ] Mite (2000 & younger) [ ] Squirt
(1998-1999) *DUES: MITE
$399.00
[ ] PeeWee (1996-1997) [ ] Bantam
(1994-1995) SQUIRT AND ABOVE
$499.00
CC#________________________________
GOALIE $290.00
USA Hockey most be done on line.
At www.usahockey.com
Exp. Date___________________________
Amount $___________________________
REFUNDS: There will
be no refunds. Please make checks payable to “ICEOPLEX”.
DUES COVER:
EVALUATION + 11 GAMES & 11 PRATICES, & TWO WEEKS PLAYOFF.
28 TIMES ON THE ICE.
Please Ready Carefully!
WAIVER AND RELEASE OF LIABILITY
EASY STREET ARENA/MANAGED BY ICEOPLEX, H.A.S. INC
& AFFILIATED BUSINESSES
(Hereafter referred to as “EASY STREET/MANAGED BY
ICEOPLEX)
In consideration of being allowed to participate in any
way in sports and other activities at or by ICEOPLEX/EASY STREET, the
undersigned acknowledges and agrees as follows:
1.
I acknowledge and fully understand that I will be engaging in activities
that involve risk of serious injury, including permanent disability and death
and severe social and economic losses which might result not only from my own
actions, inaction’s, or negligence, but also from the action, inaction or
negligence of others, the rules of play, or the condition of the premises or
competition area or any equipment used, further, that there may be other risks
not known to me or not reasonably foreseeable at this time.
2.
I agree that prior to participating in any activity sponsored by Easy
Street/Managed by Iceoplex. I will inspect the competition area and all
equipment to be used, and if through my inspection, I determine that anything
related to that activity is unsafe, I will immediately advise my coach or an
official of Easy Street/Managed by Iceoplex, of this unsafe condition and will
not participate until the condition is corrected.
3.
I assume all foregoing risks and accept personal responsibility for the
damages following such injury, permanent disability, or death.
4.
I release, waive, discharge, and covenant not to sue Easy Street/Managed
by Iceoplex, its affiliated clubs. Their respective administrators, directors,
agents, attorneys, coaches, and other employees of the organization, other
participants, sponsoring agencies, sponsors, advertisers, and, if applicable,
owners and lessors of premises used to conduct the event, all of which are
caused or alleged to be caused in whole or in part by the negligence of the
releasees or otherwise.
I HAVE READ THE ABOVE WAIVER
AND RELEASE AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT
AND SIGN IT VOLUNTARILY. I ALSO AGREE TO ABIDE BY ALL RULES OF THE EASY
STREET/MANAGED BY ICEOPLEX YOUTH HOCKEY PROGRAM.
Date: __________________ Signature:
______________________ Signature: __________________________
Player Parent or Guardian
 
YOUTH HOCKEY
FALL 2008
14 Weeks Season
A Youth Hockey
Program That’s Fun! ¨
For All Hockey Players, Boys and Girls, Mite - Bantam
MARINERS HOCKEY
PROGRAM ¨
MITE - BANTAM
Mite -$399 * Squirt – Bantam -
$499*Goalies -$290
(USA
Hockey registration on line at www.usahockey.com)
*Must
provide proof of USA Hockey at Registration
28 Total On-Ice Sessions
2 Practice
game / scrimmage for Evaluation
11 Practice
sessions
11 Regular
season games
2 Play-off
games (all teams make the play-offs)
Trophies for
all players
Program Starts: Friday, September 5th, 2008
For Further Information
call Luc Beausoleil 805-520-7465 Ext 18 or
luc@iceoplex.com
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