TeamPages: Spokane Youth Hockey - 2018 Middle School Hockey Registration

2018 Middle School Hockey Registration

Welcome to the registration for the Spokane Youth Hockey’s Middle School Hockey program. The Middle School Hockey program is open to all current 6th, 7th and 8th grade students from all Associations and for all levels of play. Cost for the league will be $265 per player, and will include a league jersey. Players will be grouped (as best as possible) according to their middle schools/school districts/regional area – North, South, East and West.

Middle School Rate Skate will be held on Monday, March 26th from 7:30-8:30 PM on Rink 1.

League play will begin April 9 and run through May 21. All Middle School Hockey League games will be played on Monday nights at Eagles Ice Arena (6321 North Addison Spokane, WA 99208). Game times will be 7:15-8:15 PM or 7:30-8:30 PM (full schedule will be posted upon team formation following Rate Skate).

Coaches!

Interested in coaching? Please fill out this SAYHA Middle School Coaching Application. A coaching credit will be offered for each Middle School Head Coach who can commit to attending Rate Skate and all 7 weeks of league play (coach selections will be made by Neil Runbeck, Director of Hockey Operations). Thank you!

Payment Instructions

Your transaction will be completed through PayPal. A PayPal account is NOT required. You will have the option to choose to pay via credit or debit card or with your PayPal account when you get to the PayPal log-in screen. A successful registration will provide you with a receipt via PayPal. Spokane Youth Hockey will also email a receipt within 24 hours. If you do not receive a PayPal receipt and/or a Spokane Youth Hockey receipt, your player has not been successfully registered and you will need to contact our office (or re-submit this form). Thank you!

Please Note: If you are having problems checking out with this form using your PayPal account, please log into PayPal and verify that all payment information is correct for your account. Some users have experienced problems checking out with this form due to PayPal financial information not being updated (i.e. an outdated expiration number).

*Player Information

Name:

*Player Address:

Street Address:
City: State/Province: Country: Zip/Postal Code:

*Player Birth Date

*Gender

MaleFemale

*Middle School or Grade School Where Player Currently Attends:

*Player’s School District:

*Number of Years Played

*Parent/Guardian 1 Name

Name:

*Parent/Guardian 1 Address:

Street Address:
City: State/Province: Country: Zip/Postal Code:

*Parent/Guardian 1 Phone Number (best number for coach/admin to contact your player):

*Parent/Guardian 1 Email Address:

*Medical Insurance Company

*Medical Insurance Policy Number

*Emergency Contact

Name:

*Emergency Contact Phone Number:

*Hospital of Choice

Please list any restrictions on activity:

Consent to Treat Certification

I certify that on this date, as the parent or guardian of the player that I am registering, that I give my consent to Spokane Youth Hockey and its medical representative to obtain medical care from any licensed physician, hospital or clinic for the above mentioned participant, for any injury that could arise from participation in this league.

*Parent/Guardian Signature (please type in your full name):

SAYHA Concussion Information

Please read the Spokane Youth Hockey Concussion Information and acknowledge receipt thereof below.

*I/We have read, understand and acknowledge receipt of Concussion Information from Spokane Youth Hockey. This is further acknowledged by our digital signatures below.

*Player Signature (please type your full name):

*Parent/Guardian Signature (please type your full name):

Parent Code of Conduct

Please read the Spokane Youth Hockey Parent Code of Conduct and acknowledge adherence to the policy for all members of the registered player’s family.

*I/We have read, understand and acknowledge the Spokane Youth Hockey Parent Code of Conduct and agree to abide by the policy.

Player Code of Conduct

Players agree to abide by all league rules and to conduct themselves according to the USA Hockey Player Code of Conduct, along with the Spokane Youth Hockey Locker Room Policy.

*Player Signature (please type your full name):

Waiver of Liability, Financial Acknowledgement and Privacy Policy

By registering with Spokane Americans Youth Hockey Association (SAYHA), the participant and his/her parents or guardians consents to participate at his/her own risk. SAYHA and its owners, employees or agents, shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant or his/her family in relation to any SAYHA programs. Participants and parents assume full responsibility for all injuries and damages which occur in relation to any programs. He/She does hereby fully and forever release, discharge and hold harmless SAYHA, all associated facilities and its owners, employees, and agents from any and all claims, demands, damages or rights of action, present or future, resulting from any person’s participation in any programs or use of the facility. In addition, he/she agree(s) to follow the rules of conduct and play set by USA Hockey. Failure to do so may result in suspension from participation. By registering, you authorize SAYHA and its assigns to utilize any and all photographs, pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in promotional materials or team films.

Financial Obligations

By registering with SAYHA, participant and his/her parents or guardian agree to pay all incurred fees due SAYHA.

Any returned NSF checks will result in a fee of $25 being added to your account.

Privacy Policy

We take your right to privacy seriously. This Privacy Policy deals with personally identifiable information that may be collected by us on our site. SAYHA collects data provided by you only when the data is voluntarily submitted in forms. If you contact us by email, we may keep a record of that correspondence for future reference. We use the information you provide about yourself and your child when submitting a form only to process the request. We do not share this information with outside parties except to the extent necessary to process the request or for legal process, to establish or exercise our legal rights or defend against legal claims, to investigate, prevent, or take action regarding illegal activities, suspected fraud, situations involving potential threats to the physical safety of any person, violations, or as otherwise required by law.

*I/We have read, understand and agree to comply with the Spokane Youth Hockey Waiver of Liability, Financial Obligations and Privacy Policy. This is acknowledged by our digital signatures below.

*Player Signature (please type your full name):

*Parent/Guardian Signature (please type your full name):

*Refund Policy: I understand and acknowledge that the evaluation fees are non-refundable except upon receipt of a medical report from a qualified physician stating that the registered player is unable to participate due to medical reasons.

$ 265.00 is due with completion of the form.

or cancel

Spokane Youth Hockey

2018 Middle School Hockey Registration

Pricing Details

Total: $ 265.00

2018 Middle School Hockey Registration

Coaches!

Payment Instructions

Consent to Treat Certification

SAYHA Concussion Information

Parent Code of Conduct

Player Code of Conduct

Waiver of Liability, Financial Acknowledgement and Privacy Policy

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