Signature and Waiver (Please Print)

We hereby acknowledge the authority of the CHA, BCAHA, OMAHA, and the Summerland Minor Hockey Association, and agree to carry out and abide by the Constitution, Bylaws, Rules and Regulations of those associations.

EQUIPMENT: We, a the end of the season covered by this registration, agree to return all equipment provided by the Minor Hockey Association in good condition and should we fail to do so we agree to reimburse the Association for the replacement cost of the same.

RELEASE: In consideration of this application to play under the auspices of the Summerland Minor Hockey Association, I do hereby for myself, heirs, executors, administrators and assigns, remise, release and forever discharge the CHA, BCAHA, PCAHA, the Association, its officers, or anyone acting on their behalf from all manner of litigation, damage claims, or demand in law or equity which I may have or acquire by reason of personal injury to the player, loss or damage to property, which may occur during or by reason of participation in the activities of the Association.

Date:________________________________

Player signature:_____________________________________________

Parent/Guardian signature:_______________________________________

        I understand that it is my responsibility to keep the team management advised of any change in the "Player Medical Information Sheet" as soon as possible and that in the event no one can be contacted, team management will take my child to hospital/M.D. if deemed necessary.
        I hereby authorize the physician and nursing staff to undertake examination, investigation and necessary treatment of my child.
        I also authorize release of information to appropriate people (coach, physician) as deemed necessary.

Date:______________________________________

Parent/Guardian signature:_________________________________________