THE PROGRAM
WAIVER FORM
Please complete the information
below:
Player’s name:
___________________________________________________________
Mailing address:
__________________________________________________________
City:
__________________________________ State:_________ Zip:_______________
Telephone:
_________________________________D.O.B.: ______________________
POLICY HOLDER’S NAME:
______________________________________________
INSURANCE COMPANY:
________________________________________________
INSURANCE NUMBER:
__________________________________________________
RELEASE
OF LIABILITY AND CODE OF CONDUCT
Upon entering events sponsored by Bob Walsh and/or
The Program, I/We understand and appreciate that participation or observation of
the sport of hockey, in all forms, constitutes a risk to me/us of serious injury
including permanent or observation of the paralysis or death.
I/We voluntarily recognize, accept and assume this risk and release The
Program, Bob Walsh, and The Bridgewater Ice Arena, LLC, their affiliates,
spouses and families, staff members, event organizers and officials from any and
all liabilities thereof.
Understanding that the safety and an enjoyable
learning experience of all players and individuals involved in The Program is of
the utmost concern; the signature below indicate that the player and parents
agree to act in good conduct and responsibility while in and around The Program
and The Bridgewater Ice Arena. Understanding
that fighting, taunting, hazing, destruction of any property and/or any
otherwise mischievous activities are not acceptable behaviors and may result in
immediate expulsion from The Program and The Bridgewater ice Arena without
refunds or prorations. Players and parents understand that such actions, depending
upon the severity may involve local authorities as well.
The Program’s goal is to make hockey ready to
compete at the top of their game with the ideal and dignity of good
sportsmanship and to challenge those players to become the best they can be
physically and mentally.
PARENT’S NAME: (PRINT):
_____________________________________________________________
PARENT’S SIGNATURE:
_______________________________________________________________
PLAYER’S SIGNATURE:
_______________________________________________________________
THIS FORM MUST BE FILLED OUT. IT MUST ACCOMPANY THE PLAYER ON HIS/HER FIRST NIGHT HE/SHE
INTENDS TO SKATE ON THE ICE AND BE TURNED IN AT THE REGISTRATION TABLE.