2016-17 Winter Green Stars

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Player First Name *

Player Last Name *

Address *

City *

State *

Zip Code *

Date of Birth *

Players age *

Daytime Phone *

Evening Phone *

Email *

Choose a session *

2016-17 Cenior Rhino Hockey Fall Session (Player cost $99 due by Aug. 31st after Aug. 31st $129)

2016-17 Cenior Rhino Hockey Winter Session (Player Cost $266 Due by Sept. 1st after Sept. 1st $296

2016-17 Both Cenior Rhino Fall & Winter Session (Player cost $335.00 due by Aug. 31st after Aug. 31st $365)

Pay with Credit Card

A separate $50.00 check is required for a security deposit for your socks and jersey. The check will not be cashed unless these items are not returned at the end of the season.

Highest Level Played *

Jr. C, Var. SD HS - 4 pts

Bantam, PW, SQ, Some Youth Hockey - 7 pts

Pond Hockey - 9 pts

Began Playing as an Adult - 15 pts

Years of Play *

Player Age *

Player score - Add up all points from above *

Position Played

Forward

Defense

Goalie

Photo Release

By checking this box, I grant to Rhino Hockey, LLC the right to take photographs of me in connection with the above-identified organization. I authorize RHLLC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that RHLLC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Waiver: I assume all risks and hazards incidental to such participation and do hereby waive, release, absolve, indemnify, and agree to hold harmless Rhino Hockey L.L.C., the organization, sponsors, supervisors, participants, coaches, captains, officials, and its associates for any claim arising out of an injury of accident. *

Renew USA Hockey Number copy and paste this link in a browser USA Hockey registration required. See Cenior Rhino menu section of site for details. Your USAHockey numbers is still good till Aug. 31st 2018

USA Hockey Registration # *

USA Hockey registration required. See Cenior Rhino menu section of site for details.

Insurance Carrier *

Player Signature *

Today's Date *

ROOKIE RULE: NEW PLAYER TO THE LEAGUE THAT WOULD LIKE TO PLAY WITH ANOTHER PLAYER IN THE LEAGUE