2017-18 Jr. Rhino101 Fall Camp/Winter Session Registration 2017-18 Jr. Rhino101 Fall Camp / Winter Session Registration First Name * Last Name Address City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * DOB * Players Age * 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Years Played 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Position * Forward Defense Mom's Name * Mom's Phone * Mom's Email * Dad's Name * Dad's Phone * Dad's Email * Session Options * Jr. Rhino 101 Fall Session Age 4-18 (Cost $200.00 if paid by Aug. 31st, $256 after Aug. 31st) Jr. Rhino 101 Winter Session 4-18 (Cost $226 if paid by Aug. 31st, $256 after Aug. 31st) Both Jr. Rhino 101 Fall/Winter Session Age 4-18 (Cost $372 if paid by Aug. 31st, $422 after Aug. 31st) Pay Your Registration with Credit Card Jersey Deposit Address to mail Jersey Deposit Jerseys & Socks Gear Rental * I require rental forward/defense equipment (An additional $50 fee is required for rental equipment. A separate $200 check for a security deposit is also required for all rentals) I will provide my own equipment Jersey Size * YS YM YL YXL AS AM AL AXL T-Shirt Size * YS YM YL YXL AS AM AL AXL Waiver: I hereby give my approval for my child's participation in the Jr. Rhino Hockey Winter Session. I assume all risks, responsibilities, and hazards incidental to such participation and so hereby waive, release, absolve, indemnify, and agree to hold harmless Rhino Hockey L.L.C and its subsidiaries, sponsors, supervisors, paticipants, coaches, referees, Scheels IcePlex, and its associates for any claims arising out of an injury to my child. Also, my signature gives permissions for my child to be admitted and attended to for medical or dental treatment in case of injury or illness. * Photo Waiver * By checking this box, I grant to Rhino Hockey, LLC the right to take photographs of my child 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 my child with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. No I dont want my childs photograph to be used for marketing material Insurance Carrier * Parent or Gaurdian Signature * Today's Date * reCAPTCHA Submit If you are human, leave this field blank.