Carmel Recreation and Parks Department In-Line

Michael Geary Memorial Rink Carmel Recreation and Parks Department ____ 740 Route 6, Mahopac, NY 10541 790 Long Pond Road, Mahopac, NY 10541 www.mahopacrollerhockey.com (845) 628-7888

ROLLER HOCKEY PROGRAM REGISTRATION

Player Name ______D. O. B. ______Age (Today)______

Parent/Guardian Name (if player is under age 18)______Cell Phone: ______Street Address ______Home Phone: ______Work Phone: ______City ______State ______Zip ______E-Mail: ______

PLEASE NOTE: ALL REGISTRATIONS MUST BE DONE THROUGH THE RECREATION OFFICE AT SYCAMORE PARK!! (In person registrations are taken Monday through Friday, 9:00 a.m. – 4:00 p.m.; mail-in registrations are also accepted.) *Town of Carmel Residents must purchase current year Resident ID Cards to qualify for Resident Fee; proof of residency is required.* Make checks payable to Carmel Recreation. In memo please write: “Geary League.”

* Resident Non-Resident Fee Fee

______Clinic – Atoms Division (ages 3-5 years and ages 6 and 7 years for first time players) $55 $75 Check ______Youth League (ages 6 – 17 years) $75 $95 Program ______Adult League (ages 18 years and older) $75 $95

FALL ______or SPRING ______(indicate which session)

Coaches are always welcome. One registration fee will be waived for those who volunteer to coach. Interested? YES or NO I would like to help the league with ______

Experience: Which League?/Level? In-House or Travel?/Level? Position Played? How Long? Roller ______Ice ______

Check all that apply: I am interested in playing goalie. ______I am interested in a travel program. ______

I give permission for the above named player to participate in the roller hockey league. I also agree to the release of all liability on behalf of myself/my child for all Town of Carmel / Carmel Recreation & Parks Dept. and its agents or representatives. I acknowledge the risks and dangers associated with the sport of roller hockey and voluntarily accept and assume liability and the possibility of injury, damage or loss on my behalf or that of my child. I waive any and all claims against the Town of Carmel. I also give consent for the above named player (self or child) to receive hospital treatment if necessary. The municipality does not hold accident insurance; insurance is the responsibility of the individual.

CARMEL RECREATION ROLLER HOCKEY IS A ZERO TOLERANCE LEAGUE. GOOD SPORTSMANSHIP IS PROMOTED & IS EXPECTED FROM ALL PLAYERS, PARENTS AND SPECTATORS. INAPPROPRIATE LANGUAGE, COMMENTS, BEHAVIOR OR GESTURES WILL NOT BE TOLERATED. SUCH BEHAVIOR WILL RESULT IN SUSPENSION FROM THE LEAGUE, WITH FORFEITURE OF FEES!

Player or Parent/Guardian Signature: ______Date:______

Emergency Contact Person: Home Cell Name:______Phone:______Phone:______

Town of Carmel Recreation and Parks / Mahopac Roller Hockey Association

CODE OF ETHICS

I hereby pledge to provide positive support, care, and encouragement by following this Code of Ethics Pledge.

 I / my child will encourage good sportsmanship by demonstrating positive support for all players, coaches, and officials at every game, practice, or other sports event.

 I / my child will place the emotional and physical well-being of others ahead of a personal desire to win.

 I / my child will insist on playing in a safe and healthy environment.

 I / my child will support coaches and officials in order to encourage a positive and enjoyable experience for all.

 I / my child will demand a sports environment that is free of drugs, tobacco, and alcohol, and will refrain from their use at all sports events.

 I / my child will treat other players, coaches, fans, and officials with respect regardless of race, sex, creed, or ability.

NOTE: - Failure to sign this document will make me/my child ineligible to participate in any Carmel Recreation / MRHA sponsored activity for the season. - Failure to abide by the above Code of Ethics Pledge will result in my / my child’s suspension from any Carmel Recreation / MRHA activity for the season and will result in a loss of any fees paid.

______PLEASE PRINT NAME PLAYER OR PARENT/GUARDIAN SIGNATURE