PLAYER REGISTRATION FORM – HEADS UP HOCKEY

PLAYER REGISTRATION

Player Registration Form

Player Name

Birth Date

Winter 2024 Organization/Team

Position

Left Wing, Center, Left Defense, Goalie, etc...

Skills You'd Like to See Immediate Improvement In

Shooting, Passing, Goal-Scoring, Skating Ability, Speed, Decision-Making, etc...

Goals

Make a club team, Play College Hockey, Play Professionally, etc...

Because playing hockey can be strenuous and subject to the risk of serious injury, Heads Up Hockey, LLC and Jonathan Suporn urge you to obtain a physical examination from a doctor before beginning any training session. You agree that by participating in these on-ice or off-ice sessions or personal training activities, you, or your child, do so entirely at your own risk. This includes, without limitation, (a) your use of all amenities and equipment in the facility and any off-site location and your participation in any activity, class, program, personal training, or instruction, (b) the sudden and unforeseen malfunctioning of any equipment, (c) our instruction, training, supervision, or dietary recommendations. You agree that you, or your child, are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury. You, or your child, expressly agree to release and discharge Heads Up Hockey, LLC and Jonathan Suporn from any and all claims or causes of action. This waiver and release of liability include, without limitation, all injuries to you which may occur, regardless of negligence. If any portion of this release from liability shall be deemed by a Court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect, and the offending provision or provisions severed here from. You, or your child, acknowledge that you have carefully read this waiver and release and fully understand that it is a release of liability. You agree to voluntarily give up any right that you may otherwise have to bring legal action against Heads Up Hockey, LLC and Jonathan Suporn for negligence, or any other personal injury or property damage or loss action. Any legal costs for Heads Up Hockey, LLC and Jonathan Suporn associated with a lawsuit challenging this waiver are the sole responsibility of the plaintiff. This agreement is bound by the laws of the State of Massachusetts. *

I give the player stated here permission to participate in this camp pursuant to all the terms and regulations that apply on the Waiver & Release form.

Signed (Parent Name): *