ࡱ> @B?M bjbj== "FWW l      RTTTTTT$ x x   "  R R   `qŒ-6  <0   Moorestown Youth Street Hockey Association (MYSHA) Registration FormPRINT LEGIBLYPARENT CONTACT INFORMATIONPARENTS/GUARDIANS: (LAST NAME, FIRST NAMES)ADDRESS:HOME PHONE:EMERGENCY PHONE:E-MAIL ADDRESS:Waiver/Release/Medical-Authorization/Conduct I, the parent of ________________, in consideration for my child being allowed to participate in any and all MYSHA activities, including but not limited to tryouts, practices, games and/or events, acknowledge that I have read, understood, and agree to the terms of this waiver/release and medical authorization. I acknowledge that there are risks connected with allowing my child to participate in MYSHA activities, including but not limited to, those associated with weather conditions, playing conditions, equipment, facilities, other participants, and the possibility of collisions, any or all of which could result in injury or even death, and I acknowledge and assume them by allowing my child to participate. I assume all risks and hazards incident to such participation, as well as the risks and hazards incidental to and arising from the transport of my child to and from the activity. I release and discharge MYSHA, its officials, organizers, participants, members, parents, owners, sponsors and lessors of the premises used to conduct the MYSHA activities, volunteers, equipment manufacturers and persons transporting my child to and from MYSHA activities, for any and all loss, liability, damage, cost, expense, action, suit and demand what so ever in law or equity arising from, based upon or leading to personal injury or death to, or damage to or loss of property of my child or me, sustained in connection with my childs participation in MYSHA activities. I represent that my child is physically able to participate in MYSHA activities, and is not subject to any medical condition that may pose a risk of harm to others. If my child requires any special medication, or has any medical conditions, I have listed it/them below. In case of an emergency need for medical treatment, I authorize MYSHA to transport my child under a legal physician, and administer treatment. As a PARENT I will cheer for ALL the players on each Team and demonstrate good sportsmanship. I will be supportive when my child/team is successful OR struggling and whether the Team wins or loses. I will show respect for the Referees, opposing fans and the other fans. As a COACH I will model good sportsmanship and will enact MYSHAs Fair Play Policy. PARENT SIGNATURE:DATE:PLAYER INFORMATIONPLAYERS LAST NAME, FIRST NAME:MEDICATIONS & MEDICAL CONDITIONS:BIRTH DATE (MM/DD/YY):For Street: AGE ON JANUARY 1ST NEXT YEAR:HEALTH INS:For Roller: AGE ON JANUARY 1ST THIS YEAR:DIVISION:[ ] Half Pint (Ages 5-6)HEIGHT/WEIGHT: Average Above Average[ ] Mite (Ages 7-9)JERSEY NUMBER: ____, ____, ____[ ] Bantam (Ages 10-12)[ ] Cadet (Ages 13-15)[ ] PLAYER IS A GOALIE [ ] Cruiser (Ages 16-18) VOLUNTEER OPPORTUNITIESILL VOLUNTEER TO COACH:[ ] Half Pint[ ] Mite[ ] Bantam[ ] CadetILL VOLUNTEER FOR:[ ] Referee[ ] Team Mom[ ] MYSHA Admin PositionPAYMENTInclude CASH or CHECK Payable to MYSHA : $60 Ages 7-15 or $35 Ages 5-6 Family Discount: 2 Children - $90, 3 children $120, 4 Children $150AMOUNT:[ ]CHECK #:[ ] CASH PLAYER EVALUATION SCORES (Filled-In by Evaluators)(1) ____/____(2) ____/____(3) ____/____AVG ____/____FINAL _______ DEFGHVYtu   BCZ^dfivxy}'8_ 5CJ\ 5>*\5CJH*>*CJ5\ 5CJ\CJ 5CJ\>*OJQJCJCJ CJOEFGHVWX<$If $$Ifa$X$$Ifl''064 la$IfXYtupICCI(C$IfX$$Ifl''064 la$IfX$$Ifl''064 lax6Dk$$Ifl0V'064 la$IfX$$Ifl''064 la IX$$Ifl''064 la$IfX$$Ifl''064 la  #IdX$$Ifl''064 la$IfX$$Ifl''064 la 6P0$IfX$$Ifl''064 la$Ifk$$Ifl0V'064 la  BCZ$IfX$$Ifl''064 laL$Ifk$$Ifl0H'064 la'TUVqr{{{x{{{$If~$$IflFH'  06    4 larstyyy$If$$Ifl4FH'  06    4 la{u$If$If~$$IflFH'  06    4 laIdC$IfX$$Ifl''064 la$IfX$$Ifl''064 la)4AM8$IfX$$Ifl''064 laMNbp[8UUUUU$If$$Iflr@ I!' iw X064 la[U$If$$Iflr@ I!' iw X064 la789$ID@I:$If $$Ifa$X$$Ifl''064 la$IfX$$Ifl''064 la9AOZ[\]^U $$Iflr{bI0'064 la$If^_F@$IfX$$Ifl''064 la $$Ifa$X$$Ifl''064 la4$IfY$$Ifl4''064 laCJCJ5\[U$If$$Iflr{bI0'064 laX$$Ifl''064 la 1h/ =!"#$% i8@8 NormalCJ_HaJmH sH tH :@: Heading 1$$@&a$>*CJ6@6 Heading 2$$@&a$CJ$6@6 Heading 3$@& 5CJ\8@8 Heading 4$$@&a$5\<A@< Default Paragraph Font F z z EFGHVWXYtu   B C Z    ' T U V q r s t  ) 4 A M N b p  7 8 9 A O Z [ \ ] ^ _ 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 X  rM9^ !"   :Hu C  9 _ Kenneth W. RupinKenneth W. RupinKenneth W. RupinKenneth W. RupinKenneth W. RupinKenneth W. RupinBrendan Handlan Unknown User3C:\WINDOWS\Desktop\MYSHA Registration Form Word.docEFGHVWXYtu   B C Z    ' T U V q r s t  ) 4 A M N b p  7 8 9 A O Z [ \ ^ _ @ Tj{ H P@UnknownG:Times New Roman5Symbol3& :Arial?& Arial Black"qh棓棓b|u  !203HDMoorestown Youth Street Hockey Association (MYSHA) Registration FormKenneth W. Rupin Unknown UserZOh+'0$0@ Xd    EMoorestown Youth Street Hockey Association (MYSHA) Registration FormioorKenneth W. RupinStrennennNormal  Unknown Userpin2knMicrosoft Word 9.0r@^в@.*@-@-u Z՜.+,00 hp  NSWCDD EMoorestown Youth Street Hockey Association (MYSHA) Registration Form Title  !"#%&'()*+,-.012345689:;<=>ARoot Entry F`qŒ-C1Table$WordDocument"FSummaryInformation(/DocumentSummaryInformation87CompObjjObjectPool`qŒ-`qŒ-  FMicrosoft Word Document MSWordDocWord.Document.89q