INNISFAIL MINOR HOCKEYREGISTRATION FORM
2016 - 2017
Box 6028, Innisfail, Alberta T4G 1S7
Phone (403) 227-5620 Fax (403) 227-5625
Email:
Website
PARTICIPANTINFORMATIONName:
Address:
Legal Land Location (applicable to all rural and box # addresses):
Postal Code: / Phone Number:
Date of Birth: / Male Female
Preferred Position: (please circle one) Goal Defence Forward
Level registering for: eg. 1st yr Atom, 2nd yr Pee Wee / In what Town/City did you last play in:
Does the participant have any medical condition IMHA needs to be aware of:
PARENT INFORMATION
Parent/Guardian: / Home Phone: / Cell Phone:
Parent/Guardian: / Home Phone: / Cell Phone:
Email Address:
Parent or Guardian: I/We do hereby release, absolve, indemnify, and save harmless The Innisfail Minor Hockey Association, their executive, staff, supervisors and instructors; The Town of Innisfail, their supervisors and staff, any and all of them from any claims which I/We or said child may have as a result of our participation. I/We do assume all risks and hazards incidental to this activity to include lacerations, bone breakage, sprains, strains, contusions, concussions, etc and hereby waive any claims which I/We or the said child may have against the above mentioned organizations or individuals.
______
Signature Date
Tryout times & groups will be posted online in mid August.
Registration Fees for 2016– 2017
*Note – Early Bird Fees in effect until June 30th, 2016
/ (Checkall Applicable) / Born / *Early Bird Fees / Regular Fee / Total Fees
Initiation Division
Eaglets(1st yr only) / 2012 / $125.00 / $125.00 / $______
Dynamite / 2010-2011 / $360.00 / $360.00 / $______
Male Division
Novice / 2008-2009 / $490.00 / $490.00 / $______
Atom / 2006-2007 / $565.00 / $715.00 / $______
Pee Wee / 2004-2005 / $640.00 / $790.00 / $______
Bantam / 2002-2003 / $700.00 / $850.00 / $______
Midget / 1999-2000-2001 / $730.00 / $880.00 / $______
Female Division
Novice Female / 2008-2009 / $490.00 / $490.00 / $______
Atom Female / 2006-2007 / $565.00 / $715.00 / $______
Pee Wee Female / 2004-2005 / $640.00 / $790.00 / $______
Bantam Female / 2002-2003 / $700.00 / $850.00 / $______
Midget Female / 1999-2000-2001 / $730.00 / $880.00 / $______
September Ice - Evaluation / Conditioning & Female Development Camp, and Import Fees
Tier 1 Evaluation/Conditioning Fee(Atom, Peewee, Bantam, Midget) Non Refundable / $100.00
Tier 2 Evaluation/Conditioning Fee(Atom, Peewee)Non Refundable / $50.00
Import Fee / $50.00
*Note – Early Bird Feesare in effect until June 30th, 2016. Please note that the early rate for Eaglet, Dynamite and Novice has been extended until September.
All import players (non-resident players) must include the Import Fee of $50.00.
Import players will be subject to the IMHA Import Policy.
*Registration will be complete once Respect in Sports (Parent) online course is completed.
(Check One)
Cash / Cheque / TOTAL PAYMENT:
Post Dated Payment Options
50% of Fees due June 30, 2016 / Chq. # / Amount:
25% of Fees due July 31, 2016 / Chq. # / Amount:
25% of Fees due Aug. 31, 2016 / Chq. # / Amount:
**NOTICE**
Fees must be paid in full by Sept. 1/2016.
**Players may not be allowed on the ice until all fees are paid in full.**
Registrations submitted after September 1st will only be accepted if there is still room in the program.
IMHA also requires a jersey deposit for all Midget Players.
Please include a separate cheque dated April 1, 2017 for $125.00.
IMHA reserves the right to accept or deny any registration at the discretion of the IMHA Board of Directors.