2016 – 2017AURORA ICE HOUSE/TRAVEL PLAYER REGISTRATION

PLAYER BIRTH YEAR / DIVISION, AND FEE INFORMATION

□MITE HOUSE $350 (’08 & after) □ SQUIRTS HOUSE $600(‘06‘07)

□ PEE WEE HOUSE$600 (‘04 & ‘05) □BANTAMMOHL $800 (’02 & ’03)□ MIDGET MOHL $800 (’00 & ’01)

□ SQUIRTS TRAVEL $TBD (‘06 & ‘07) □ PEE WEE TRAVEL $TBD (‘04 & ‘05) □ BANTAM TRAVEL $TBD (’02 & ’03)

* Fees do not include a jersey fee to be paid at a later date. (First year players only)

Please check the division that corresponds to your child’s birth year. Include a $100 deposit check payable to AURORA ICE ASSOCIATION with your registration. Return check and registration form to: Aurora Ice Association, 41 Riley Street, East Aurora, NY 14052. All players must also register with USA Hockey ($30 fee) prior to registering. Go to to register.
PLAYER INFORMATION______

Player Name: ______

Address: ______

Date of Birth: ______Phone: ______School: ______

e-mail addresses: ______

Previous Hockey Experience: ______

PARENT INFORMATION______

Father’s Name: ______Mother’s Name: ______

Father’s e-mail: ______Mother’s e-mail: ______

Father’s Phone: ______Mother’s Phone: ______

□ I/WE have an interest in helping to coach or manage my child’s team

□ I/WE have an interest in volunteering with the administration of the league with the youth hockey committee

INSURANCE / MEDICAL INFORMATION______

Insurance Provider: ______Policy # ______

Player’s USA HOCKEY Member # (MUST HAVE to register): ______

Medical Conditions Coaches should be aware of: ______

WAIVER OF LIABILITY, RELEASE
ASSUMPTION OF RISK & INDEMNIFY AGREEMENT

Participant and his/her parents/guardians recognize and appreciate that ice hockey is inherently dangerous and there exists the possibility for injuries, including serious injuries and death. We recognize and understand that Participant assumes the risk of any injuries, including death while participating in ice hockey. Participant and his/her parents/guardians agree to indemnify and hold harmless, and absolve from all liability Aurora Ice Association Inc., its officer, directors, employees and coaches or volunteers from any personal injury, death or property damage arising from participation in ice hockey. Participant, and his/her parents/guardian, give permission to participate in the Aurora Ice club hockey and training programs and in the event of injury or illness to Participant, we hereby grant authority to a qualified physician or emergency personnel to render such medical treatment as said physician or emergency personnel deems necessary under the circumstances.

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Parent or guardian’s signatureDate

Aurora Ice Hockey…

Empowering kids through teamwork, sportsmanship and fun

Have your child jointhe Aurora Ice community based youth hockey program this fall as we launch our second year of excitement, opportunity and outdoor recreation at the Winter Classic Rink in the heart of the village.

The Aurora Ice Association is committed to building a youth hockey program that personifies the values of the greater East Aurora community we serve with a specific focus on sportsmanship, respect for individuals, integrity and a love for the game of hockey.

Space is limited, please register your child ASAPby using the form on the back of this flyer or download it at our website: we can assure there will be room for them when the puck drops in Nov.