2011 AZ Memorial Day Classic ADULT Roster and Waiver

20 NARCh REGIONAL ROSTER

Team
Release Name
of Liability: Division
20 NARCh REGIONAL ROSTER
In consideration of being permitted to participate in AZ Memorial Day Classic and Smith Hockey Solutions activities, I
understand and appreciate that the risk of serious personal injury is significant, including the potential for permanent paralysis
and death andList players in and
Alphabetical Order. 15 players per roster, maximum.
Team Name Division
voluntarily assume accept those risks. I unconditionally release, waive and hold harmless Smith Hockey
Solutions, The AZ Memorial
PLAYERDay Classic, National Youth PLAYERSports Center, their affiliates, promotional
JERSEY OFFICIALsponsors and advertisers
RH A and
all their agents, volunteers and employees from any and all suits, claims and demands of any kind for personal injuries and
NAMEbut not limited to lost
property damage, including SIGNATURE
or stolen goods, whichNUMBER
may be incurred USEdueONLY MEMBER
to my participation #
in Smith
1 List activities,
Hockey Solutions players inthose
even Alphabetical Order. on15
that result due to negligence the players
part of anyW: ofper roster,
POA:
the parties maximum.
previously mentioned in this
20 NARCh REGIONAL ROSTER
release form. By participating, “I knowingly Assume Risks”, both known and unknown and understand that risks of personal
injury may2 increase PLAYER
by my participation in ice hockey PLAYER JERSEY
activities with or against W: who are
participants OFFICIAL
POA: RH A
older, faster and stronger.
NAME
SIGNATURE NUMBER USE ONLY MEMBER #
Team
1
3
Name W: Division
W:
POA:
POA:
4 W: POA:
2 W: POA:
5 List players in Alphabetical Order. 15 players
W: per roster, maximum.
POA:
3 W: POA:
6 PLAYER PLAYER JERSEY POA:
W: OFFICIAL RH A
4 NAME SIGNATURE W:
NUMBER POA:USE ONLY MEMBER #
7 W: POA:
5 1 W: W:
POA: POA:
8 W: POA:
6 2 W: W:
POA: POA:
9 W: POA:
7 3 W: W:
POA: POA:
10 W: POA:
8 4 W: W:
POA: POA:
11 W: POA:
9
12 5 W:
W: W:POA:
POA: POA:

W:W: POA:
10 W: POA:
13 6 POA:
11
14 7
GOALIE W:W: POA:
W:
POA: POA:
W:W: POA:
12
15 8
GOALIE POA:
W: POA:
13 W: POA:
9 W: POA:
TOTAL:

14 GOALIE W: POA:
10 W: POA:
Head
15 Coach
GOALIE W: POA:
11 W: POA:
Assistant Coach
TOTAL:
12
Assistant Coach W: POA:

13 W: POA:
Head Coach
Roster submitted by (PRINT NAME)
14 GOALIE W: POA:
Assistant Coach
Street Address
Assistant15
Coach
GOALIE W: POA:
City State/Prov. Zip/Postal Code
TOTAL:
Roster
Home submitted by (PRINT NAME)
# ____________________ Work # ____________________ Email _____________________________

Street Address
I hereby certify that each of the players listed above are of the proper age for this division. I further certify the above
HeadisCoach
information true and correct.

City Assistant Coach State/Prov. Zip/Postal Code

Signature Date
Assistant
Home Coach
# ____________________ Work # ____________________ Email _____________________________

I hereby certify that each of the players listed above are of the proper age for this division. I further certify the above
Roster
information submitted
is true by (PRINT NAME)
and correct.

Signature
Street Address Date

City State/Prov. Zip/Postal Code

 20 NARCh REGIONAL ROSTER
Team Name Division
20Day
2011 AZ Memorial NARCh
ClassicREGIONAL ROSTER
U18 Ironman Roster and Waiver
List players in Alphabetical Order. 15 players per roster, maximum.
Team Name
PLAYER PLAYER JERSEY Division
OFFICIAL RH A
NAME SIGNATURE USE ONLY NUMBER MEMBER #
Release of Liability:
1 List players in Alphabetical Order. 15 playersW: per roster,
In consideration of being permitted to participate in AZ Memorial Day Classic and Smith Hockeymaximum.
POA: Solutions activities, I
PLAYER
understand2 and appreciate PLAYER
that the risk of serious personal JERSEY
injury for my son or OFFICIAL
daughter is significant,
W: POA:
including the potential
RH Afor
permanent paralysis and death and voluntarily assume and accept those risks. I unconditionally release, waive and hold harmless
Smith Hockey NAME
Solutions, SIGNATURE
The AZ Memorial Day Classic, NUMBER
National Youth Sports Center, USE ONLY MEMBER #
3 W:their affiliates,
POA:promotional sponsors and
advertisers and all their agents, volunteers and employees from any and all suits, claimsW:
1 and demands POA: of any kind for personal
injuries and
4 property damage, including but not limited to lost or stolen goods, which W: may be incurred
POA:due to my son/daughter’s
2
participation in Smith Hockey Solutions activities, even those that result due to negligenceW: on thePOA: part of any of the parties
previously5 mentioned in this release form. By participating, “I knowingly Assume W:Risks”, both
POA: known and unknown and
3 that risks of injury to my son or daughter may increase by my participationW:
understand in ice hockeyPOA:activities with or against
6 who are older, faster and stronger.
participants W: POA:
4 W: POA:
7
Parent/ Guardian Signature______________________________________ W: Date____________________________
POA:
5 W: POA:
8 W: POA:
IRONMAN ROSTER MAY ONLY CONTAIN 4 SKATERS AND A GOALIE!
6
20 NARCh REGIONAL ROSTER W: POA:
9 W: POA:
Team
7 Name Division W: POA:
10 W: POA:
8 W:
List players in Alphabetical Order. 15 players per roster, maximum. POA:
11 W: POA:
PLAYER PLAYER JERSEY OFFICIAL RH A
9
12 NAME SIGNATURE NUMBER USE ONLY W:
MEMBER
W:
POA:
#POA:
1 W: POA:
W:W: POA:
10
13
2 W: POA: POA:
11
3
14 GOALIE W: POA: W:W: POA:
POA:
4 W: POA:
W:W: POA:
12
15
5
GOALIE
W: POA:
POA:
13
6 W: POA: W: POA: TOTAL:
7
14 GOALIE W: POA: W: POA:
8 W: POA:
Head
15 Coach
GOALIE W: POA:
9 W: POA:
Assistant
10 Coach W: POA:
TOTAL:
Assistant
11 Coach W: POA:

12 W: POA:
Head 13Coach
Roster submitted by (PRINT NAME) W: POA:

Assistant Coach
14 GOALIE W: POA:
Street Address
W: POA:
Assistant Coach
15 GOALIE

City State/Prov. Zip/Postal

TOTAL: Code

Roster
Home submitted by (PRINT NAME)
# ____________________ Work # ____________________ Email _____________________________
Head Coach
Assistant
Street
I hereby Coach
Address
certify that each of the players listed above are of the proper age for this division. I further certify the above
information is true and correct.
Assistant Coach
City State/Prov. Zip/Postal Code
Signature
Roster submitted by (PRINT NAME) Date
Home
Street # ____________________ Work # ____________________ Email _____________________________
Address

City
I hereby State/Prov.
certify that each of the players listed above are Zip/Postal Code age for this division. I further certify the above
of the proper
information is true and correct.
Home # ____________________ Work # ____________________ Email _____________________________

Signature
I hereby certify that each of the players listed above are of the proper age for this division.
information is true and correct.
Date
I further certify the above

Signature Date