MS Word Doc

Member Application Form Burlington Ladies’ Oldtimers’ Hockey Club Inc. Player's Name: ______

Address: ______City: ______Postal Code: ______

Telephone: ______Date of Birth: ______

Email Address: ______(important for newsletter mail outs)

Where did you play last year? ______

Rank your skill level : __1 (beginner) 2 3 4 5 6 ( experienced, very skilled) Preferred Position (circle one): C LW RW D GOAL

You may request ONE player to be on your team; however, that player must reciprocate your name. While every effort will be made to accommodate your request, there are NO guarantees. Name of player ______

 Spots will not be held for any player without the registration form filled out and payment included with the form.  There will be a charge of $25.00 on cheques returned N.S.F.  No refunds after Sept 1, 2017

Waiting lists could be a possibility. To avoid disappointment, please mail registration today!

Important Payment Information!

First Payment (June 1st) $275.00 Spots will not be held for any player without registration form filled out and Second Payment (September 1, 2017) $275.00 without payment. TOTAL: $550.00 You can send a post dated cheque with Goalies $100.00 50.00 +50.00 your first payment. It will not be cashed until Sept 1 st .

Cheques are to be made payable and mailed to: Burlington Ladies Oldtimers’ Hockey Club Inc. 530 Elwood Road, Burlington L7N 3C7 Waiver I wish to participate in the activities Burlington Oldtimers’ Hockey Club Inc. and hereby assume all risks and hazards incidental to such participation, including during, transportation to and from the activities. I also agree to participate within the by-laws of the Constitution. I, therefore, do hereby waive, release, absolve and agree to hold harmless the Burlington Oldtimers’ Hockey Club, its sponsors, supervisors, participants and any person transporting me to and from the activities of any claim arising out of an injury loss or damage to myself. I further acknowledge the City of Burlington By-law with respect to the consumption of alcohol on City property and agree to abide by that by-law at all times. If I am charged under this by-law, I understand the ‘Club’ may suspend me and the length of the suspension will be determined at a mandatory hearing held by the discipline committee.

Signature: ______Print Name: ______Date: ______