Om Hockey Player Registration
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Email *
Player Information
First Name *
Last Name *
Phone number
Birthday
MM
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DD
/
YYYY
Address
City
Province or State
Postal or Zip Code
Skill Level
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Allergies, chronic illness, or medical conditions
If you have any allergies, chronic illness, or medical conditions that would limit high level activtiy, please list them below
Emergency Contact Information
Name *
Phone Number *
Relationship to Player
RELEASE AND INDEMNITY I give my approval to the applicant’s participation in all activities of Om Hockey Systems Inc. and assume all risks and hazards incidental to such participation and do waive, release, absolve and indemnify and agree to hold harmless other than for willful neglect on their part Om Hockey Systems Inc., its officers, agents, employees and sponsors. Any participant names, photos, video or likeness are property of Om Hockey Systems Inc.. and may be used in future advertising and or promotion for no fee. Om Hockey Systems Inc. (OHS) will provide expert coaching and supervision the ice only. Parents/guardians must supervise their children in the dressing room before and after any OHS on ice session. OHS is also not responsible for any lost or stolen articles. I certify that the applicant is in good physical and mental health. *
Required
Digital Signature (Guardian if athlete is younger than 18) *
A copy of your responses will be emailed to the address you provided.
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