November 3-5 2017
REGISTRATION FORM
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TEAM NAME/DIVISION
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CITY
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LEAGUE/ASSOCIATION
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TEAM CONTACT NAME
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EMAIL
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CELL PHONE
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HOME PHONE
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ADDRESS
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CITY
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POSTAL CODE
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COACH (if different from above)
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EMAIL
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CELL PHONE
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HOME PHONE
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ADDRESS
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CITY
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POSTAL CODE
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SWEATER
COLOUR
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HOME
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AWAY
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SPECIAL REQUESTS: WE WILL
TRY TO HONOUR BUT CANNOT GUARANTEE
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Make cheque payable to:
AMHERSTBURG MINOR HOCKEY ASSOCIATION
C/O Chris Bozin
149 Park Lane Circle Amherstburg, ON N9V 4B3
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WAIVER:
I, (Team Manager) on behalf of my team, consent to participation in the Amherstburg Minor Hockey Association (AMHA) Tournament and assume all risks that
are accidental to such participation. I therefore agree to waive, indemnify and hold harmless AMHA and its representatives, employees, agents, servants and assigns. I certify that all players are in good physical and mental health and any exceptions have been noted by me with this application. I warrant that all of the players on my team have been given permission by their parent or legal guardian to participate in this tournament and that I am authorized to make this statement on their behalf. The Applicant acknowledges and agrees that AMHA reserves the sole and exclusive right to use any photographs or video taken during the tournament for advertising or instructional purposes contained herein. I acknowledge reading this Application and Declaration and understand the conditions herein and agree to abide by all terms.
Coach/Manager Signature Date Association Rep Signature