MID-VALLEY RAMPAGE
HIGH SCHOOL HOCKEY CLUB
Spring 2017
OPEN SKATE
COME OUT TO AN OPEN SKATE
AND MEET THE COACH AND THE TEAM
Friday March 17th 6:10pm – 7:10pm @ Leaf’s Ice Center
Monday March 20th 8:20pm-9:20pm @ Leaf’s Ice Center
25.00 for non-registered players “Will be used towards fees once registered”
REGISTRATION INFORMATION
The Rampage Hockey Club is now accepting registrations for the 2017 Spring Season.
Registration deadline:March 31st 2017
Player Cost: Skater - $525 per player ($400 for goalies)
Uniform Costs: Jerseys $60 (will also be used for Fall practice jerseys)
Spring Season Info:
Playing in: West Meadows Spring Hockey League (8 games)
Approx. April thru May
Practices (9 practices 2 Open Skates) - Leafs Ice Centre 801 Wesemann Dr. West Dundee.
Registrations can also be given to a board memberor mailed.
Rampage Hockey
P.O. Box 267
South Elgin, IL 60177
Registration can be done under registration tab on the website as well.
Questions? Please call Jim Waterson (630)336-2991 or
MID-VALLEY RAMPAGE
HIGH SCHOOL HOCKEY CLUB
SPRING 2017 REGISTRATION CHECK LIST
Please check the following list before submitting your registration.
If anything is missing, please submit asap.
SPRING 2017 REGISTRATION Form -- All information must be filled in.
PAYMENT – A down payment and jersey cost is required (300.00). If you are paying by check, please submit a check made payable to: Rampage Hockey Club
USA HOCKEY REGISTRATION -- Please confirm that you have a current USA Hockey Registration from USA Hockey. A copy of the confirmation with barcode must be received prior to the first practice.
BIRTH CERTIFICATE – (NEW PLAYERS) must submit a copy of an official birth certificate.
USA HOCKEY PARTICIPANT CODE OF CONDUCT – Signed and dated (distributed on a later date)
RAMPAGE PARENT CODE OF CONDUCT – Signed and dated (distributed on a later date)
CONTRACTUAL AGREEMENT – Signed and dated
Please return all forms to:
Rampage Hockey
P.O. Box 267
South Elgin, IL 60177
or e-mail to:
All forms must be turned in, prior to player taking the ice for practice or games. (Does not include open skate practices)
MID-VALLEY RAMPAGE
HIGH SCHOOL HOCKEY CLUB
SPRING 2017 REGISTRATION
Player’s Name______Nickname ______Date of Birth______
Address ______
Player’s Home Phone #:______Cell Phone #:______
Player’s e-mail______
School attending:______
Grade in fall of 2014: Senior Junior Sophomore Freshman
Hockey Experience (# of years) ______Position ______
Level Played Last Season ______Where? ______
Socks (32” Adult or 26” Intermediate) ______
Jersey Size --- Sm. Med. Lrg. XL. 2XL. Goalie
Number Choice: 1st______2nd______3rd______
Parent, Guardian, Step-Parent, etc.
Name:______Relationship:______
Address:______
Home Phone #:______Cell Phone #:______
E-mail______
Parent, Guardian, Step-Parent, etc. Names:______Relationship______
Address:______
Home Phone # ______Cell Phone # ______
Email: ______l ______
DEPOSIT:
Uniform costs of $60 and deposit ($300.00) must be paid at the time of registration by cash, check or credit card (make payable to Rampage High School Hockey Club) MasterCard/Visa (3% Service Charge for Credit Cards)
MID-VALLEY RAMPAGE
HIGH SCHOOL HOCKEY CLUB
CONTRACTUAL AGREEMENT SPRING 2017
I, as the parent/legal guardian of ______give my approval of his/her participation in any and all activities of the Rampage High School Hockey Club during the above listed season. I assume all risks incidental to the conduct of club activities and transportation to and from same. I agree to release, absolve, indemnify and hold harmless the Rampage High School Hockey Club organizers, sponsors, supervisors, any and all in the case of injury to the player listed above arising directly or indirectly from participation in any club activity or while being transported to and from the same and to defend them against any and all claims from the loss damages, cost, and expenses incurred by them due to any claim arising from such injury. I hereby waive all claims against the organizers, sponsors or supervisors of club activities. I release from responsibility any persons transporting the player listed above to and from any club activity.
I agree to furnish a legal birth certificate of the player listed above if requested by club league state or school officials. I will also provide proof of residence if requested to do so by the club, league, state, or school officials.
I certify to the best of my knowledge that the player listed above does not have any medical and or physical disabilities or infirmities. I will provide as requested by club officials a sports physical signed by a registered medical doctor.
I understand Rampage High School Hockey Club is not directly related to any high school or their respective districts. The Rampage High School Hockey Club is registered with the USA Hockey and sanctioned by AHAI.
Insurance intended to be a secondary policy will be purchased under the players name above from USA Hockey. The registration fee and all required documents must be received before the policy will take effect. The player listed above may not participate in club activities until this has been done. I agree that I am liable for payment of the total fees. Failure to represent the club or school in a positive manner can result in expulsion from the club without refund. Conduct determined unsuitable by the club or school could be cause for expulsion or suspension from the club.
______
Parent/Guardian Signature Date
MID-VALLEY RAMPAGE
HIGH SCHOOLHOCKEY CLUB
PROMISSORY NOTE
Promised amount: $______DATE, ______, 2017
FOR VALUE RECEIVED, I, ______(Parent/Guardian) promises to pay The Rampage Hockey Club the sum of:
______dollars ($______),
with a down payment of $______.
The remaining balance of ______will be paid by first game.
If the Borrower fails to make an installment payment when due or fails to comply with any other term of this promissory note, the loan will be considered in default. This note may be paid at any time in whole without penalty.
The Borrower must promptly inform the Club of any change in name or address or, any condition that may affect this note.
If the Club prevails in a lawsuit to collect on this note, the signor above (Parent/Guardian) will pay club's court costs, collection agency costs, and attorney's fees in an amount the court finds to be reasonable.
This note was executed on this ____ day of ______, 2016 and I acknowledge the validity of this note.
______
Signor (Parent/Guardian) Name – Print Club Representative - Print
______
Signor (Parent) - Signature Club Representative - Signature