Name:

Age:

Birth Date:

Parent First Name:

Parent Last Name:

Address:

City: State: Zip:

Email Address:

Home Tel:

Cell Phone:

Position:

'09-10 Team & Level:

Jersey Size: (please select one)

Youth Medium Large/X-Large

Mens Small Medium Large

Gear Sizes:

Desired Number:
Please have three choices, returning players will have first preference

Emergency Contact Person:

Emergency Contact Tel:

Spring season cost is $1,150 for Tier I and $875 for Tier II. Tier 1-15 practices and 3 tournaments and team uniform is included in the fee.Tier 2-10 practices - 2 Tournaments and team uniform is included in the fee. It will be the responsibility of each family to secure hotel accommodations for all tournaments. A 50% down payment is expected when you receive an invite letter or after tryouts for teams that have tryout/ID skate. Full balance must be paid at first team practice.

I, , do hereby give my approval for the player listed above to participate in the Spring 2010 Renegades Hockey Program. I fully understand that there are many inherent risks, direct and indirect in this program. Being fully aware of these risks, I am willing to permit the Player whom I am legally responsible for to participate in the program. In addition, I am willing to assume all risks inherent in and incidental to such participation, and I hereby release, absolve, indemnify and hold harmless The Renegades Hockey Club, it’s Partners, Officers, Employees, Staff and Volunteers, of any claim arising out of any injury, to me or the player. I hereby authorize and request the Renegades Hockey Club it’s Partners, Officers, Employees, Staff and Volunteers to act on my behalf according to the best judgement of the Renegades Hockey Club, it’s Partners, Officers, Employees, Staff and Volunteers under prevailing circumstances in the event of any injury, or in the event that I am not able to act for myself, or the player, or I cannot be contacted.

Total Cost: $