2017 Jr. Rhino Spring Session Registration

First Name *

Last Name *

Address *

City *

State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip *

Moms Name *

Moms Phone Number *

Moms email *

Dads Name *

Dads Phone *

Dads email

DOB

Players Age 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Years Played 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Session Options *

Jr. Rhino101 Spring Session Age 4-6 (Cost $225 if paid by Feb. 28th, $275 after March 1st 2018)

Jr. Rhino SQ/PW B Division Spring Session Ages 8-12 (Cost $225 if paid by Feb. 28th. $275 after March 1st 2018

Jr. Rhino SQ/PW A Division Spring Session Ages 8-12 (Cost $225 if paid by Feb. 28th. $275 after March 1st 2018

Session Payment

Position *

Forward

Defense

Goalie

Jersey Size * YS YM YL AS AM AL AXL AXXL AXXXL GC

T-Shirt Size YS YM YL AS AM AL AXL AXXL AXXXL

Photo Release *

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.

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. *

Insurance Carrier *

Parent or Gaurdian Signature *

Date *

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