richmond bc personal injury claim by tdelight


									Medical Waiver Form                                                                 RYRHL Features
                                                                                                                                            Richmond Youth
Last Name:                                                                              Modified NARCH rules
                                                                                       2 full-size arenas
First Name:
                                                                                       High speed painted floors

                                                                                                                                             Roller Hockey
                                                                                       Guaranteed playoffs
Postal Code:                          Phone:                                           Two referees each game
Parent/Guardian’s Name:                                                                Website:
Parent/Guardian’s Work Phone:
Emergency Contact:
                                                                                        Two 20 minute halves (time permitting)
                                                                                        4 on 4 action at all age levels                          League
                                                                                       Non-contact, fun-oriented hockey
Emergency Phone:
BC Care Card Number:
                                                                                       No off sides or icing
                                                                                       One weekend game per week, one weekday game
Good general health?               If no, please specify:
                                                                                        every other week

Does your child have any allergies? Please explain:                                 Required Equipment
                                                                                       CSA approved helmet and facemask
Please list all medication to be taken, including dosage and directions:               Elbow pads
                                                                                       Hockey gloves
   *Please note the responsibility for taking proper doses of                          Protective cup/jill
   medication cannot be assumed by staff and remains the sole
   responsibility of the participant.*                                                 Inline skates (no brakes)
                                                                                       Hockey pants/girdle
Is there any other information that will help our staff care for your
child?                                                                                 Shin pads
                                                                                       Shoulder pads
                                                                                       Hockey stick
                                                                                                                                                    Season Runs:
I am the parent and/or legal guardian of _______________________________
and I hereby authorize him/her to participate in the 2007 RYRHL season. I              Goalies must have their own helmets, NO STREET
know of no medical impediments that may result in harm or injury to my child            HOCKEY MASKS
other than those stated herein.
With signing this form, I state that I have answered the above questions to the        Goalies plastic throat protector and neck guards       April 19–June 30, 2008
best of my knowledge and I agree to participate in the program at my own risk. I        HIGHLY RECOMMENDED
recognize that there is an some element of risk in any adventure, sport, or
activity associated with the Community Association’s programs. In                       RYRHL will lend out goalie leg pads, chest
consideration of the City of Richmond and the Richmond Arenas Community
Association permitting me to participate in this program, I, the undersigned, for
                                                                                        protectors, catchers, blockers, and sticks               Registration Closes:
myself, my heirs, executors, and administrators hereby waive any claims arising
from any cause whatsoever, which I have or may have against the City of             Contact Us                                                    March 31, 2008
Richmond and/or the Community Association or their respective members for all
injury or loss including personal or property loss arising from any cause                   Richmond Youth Roller Hockey League
whatsoever, suffered by my child prior to, during or after the program and                            14140 Triangle Road
release the City of Richmond and the Community Associatio n and their                               Richmond, BC V6W 1B1
respective employees and members from any and all liability for damages
sustained due to my participation in this program.
                                                                                           Phone: 604-448–5366      Fax: 604-448-5399
As the parent and/or legal guardian of the minor participant named above, I                    
hereby authorize the City of Richmond and/or the Community Association to                          Email:
provide any necessary care or first aid that may be necessary during or in the
course of any activity sponsored or conducted by the City and/or Community              For great sponsorship opportunities,
                                                                                                call 604-448-5366
(Parent/Guardian’s Signature)                                                                City of Richmond
                                                                                             6911 No. 3 Road, Richmond, BC V6Y 2C1                City of Richmond
(Date)                                                                                       Telephone (604) 276-4107 Fax (604) 276-4132   Parks, Recreation and Cultural Services
2063042                                                                                      January 2008
League Information                                                           How to Register                                                                 Registration Form
                                                                             Registration closes March 31, 2008                             Player Name:
Division                               Price              Games/Practices
Novice (5-8) ...........................$95 ............................ 8   By Mail                                                        Address:
Atom (9-10yrs) .................... $105 ........................ 12/2
Pee-Wee (11-12yrs)............. $115 ........................ 12/2           Complete the registration form and send it with your
Bantam (13-14yrs)............... $135 ........................ 12/2          cheque or credit card information to:
Midget (15-18yrs)................ $140 ........................ 12/2                                                                        Parents e-mail:
              Ages are as of January 1, 2008                                     c/o City of Richmond
                                                                                                                                            Players e-mail:
                                                                                 14140 Triangle Road
*Goalies                                                                         Richmond, BC V6W 1B1                                       Phone #1:                        Phone #2:
Any goalies with ALL their own equipment will receive
a 50% discount on league fees.                                                         Please make cheques payable to:
                                                                                                                                            Date of Birth:
                                                                                             “City of Richmond.”                                               mm / dd / yy
Evaluation Games                                                             In Person                                                      Division:                            Age:
     Evaluation time and info will be posted at Minoru
      Arenas and the Richmond Ice Centre and on April                        Register in person at the Richmond Ice Centre
                                                                                                                                            Self Rating as a Roller hockey player
      4, 2008.                                                               (14140 Triangle Road) or Minoru Arenas (7551 Minoru
                                                                                                                                            (1 = beginner, 10 = expert) :
     It is the player’s responsibility to check the date,                   Gate). If after hours, place registrations in an envelope
      time, jersey number, and location for the first                        marked ‘RYRHL’ and slide it through the mail slot in           RYRHL division played last year
      evaluation time.                                                       the office door.                                               (if applicable):
     Evaluation times will be between April 23-25, 2008                                   **IMPORTANT NOTICE**
      with league play beginning April 26, 2008                                                                                             Years played of Ice Hockey (if applicable):
                                                                               All participants must complete the medical/waiver            House or Rep:
                                                                             form on the back of this sheet upon registration. For
League Information                                                                    more information, call 604-448-5366.
                                                                                                                                            Position preferred (forward, defence, or goalie):
     All teams make playoffs.
     Playoffs will run from June 13-30, 2008.
     Single knock-out, best-of-3 series (floor) time                                       Registration Checklist                          Jersey Deposit: $35 (refundable)
      permitting.                                                                                                                           The jersey deposit is refundable upon return of the player’s jersey
                                                                                 Did you:                                                   at the end of the season. All players are required to submit a post-

Registration and New Player                                                                Complete the Registration Form?
                                                                                                                                            dated cheque dated July 1, 2008. Failure to return the player’s
                                                                                                                                            jersey will result in a $35 charge. Cheques will be cashed on

Information Night                                                                          Complete the Waiver Form?
                                                                                                                                            July 4, 2008 for all jerseys not returned, no exceptions.

     There will be a registration and new player                                          Submit League Fees?
                                                                                                                                            Credit Card Information
      information night held at 6:00-8:00pm on Thursday,
      March 6, 2008 at the Richmond Ice Centre.                                            Submit a Separate $35 post-dated cheque
                                                                                                                                            Circle one: Visa    MasterCard     Other (specify):

                                                                                            (July 3, 2008) for a jersey?                    Card#:
Coaches and Volunteers Needed!                                                             Check your first evaluation date, time, and     Expiry Date:
     The RYRHL is looking for Coaches and Volunteers                                       location? (available April 4, 2008)
      to help make the 2008 season a success. If you are                                                                                    Cardholder’s Signature:
                                                                                            Check the website, for the most
      interested in coaching or volunteering, please call
      604-448-5366 for information.
                                                                                            recent news and updates?                        Please Complete Waiver On Reverse Side


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