Registration Form

Player's First Name: Last Name:

Street Address:

City: Zip Code:

Birth Day:(mm/dd/yyyy)

Gender:

Female Male

Grade:

Pre-school 1st 2nd 3rd 4th 5th

Which elementary school do you live near?

Closest School:

Whats position(s) do you normally play?(check all that apply)

Forward Defense

Midfield Goolkeeper

Uniform Size:

Youth Smal Youth Medium Youth Large Small Medium Large Extra-large

Permission to Play

I, the parent or guardian of the minor registrant, agree that the registrant and i will abide by all the rules of the Mighty Ducks Hockey League(MDHL). In recognizing the possibility of physical injury associated with hockey and in consideration for the "League" accepting the registrat for its hockey programs and activities, I hereby release, discharge, and/or otherwise indemnify MDHL, their employees and associated personnel and volunteers, including the facilities used for practices and games, against any claim by or on behalf of the registrant as a result of the registrant's participation in the programand/orbeing transported to or from MDHL sponsored activities, which transportation by signing below, I herebyagree and authorize the above. In addition, by signing below, I also acknowledge that i have read the cancellation policy and agree to its terms.

Parent/GuardianSignature: Date