Player Name: *
Player Address:
Player Address2:
City:
State Code:	Illinois Michigan Wisconsin Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wyoming    Zip:
Player e-mail:
Player Phone: *	- - Home Work Cell
Player Phone:	- - Home Work Cell

If you are registering for a Skills Camp or Clinic, please print the page AFTER pressing the "Submit Registration" button.   Sign the printed page and bring it with you on the first day of your training camp.

I agree that I shall provide health insurance to cover any personal injury and property damage sustained while participating in any activities or while on the premises of the Delaney Hockey Adult Clinic; the undersigned assumes all responsibility for any and all risk for damage or injury that may occur to the above named student/s as a participant in Delaney Ultimate Hockey Adult Clinic, including practices, games, skill sessions, clinics, and other activities related to the program. In consideration of such, the undersigned hereby releases and discharge the program, American Heartland Ice Arena, Kevin Delaney, it's operators, employees, agents, supervisors, instructors, and other players from all claims, demands, rights or cause of action present or future, whether known or anticipated and resulting from or arising out of or incident to the undersigned participation with the said program.

Please read and acknowledge the waiver before continuing
Check here to acknowledge that all of the information entered above is accurate and that you agree with the above liability policy.