Winter Learn To Skate Registration

Child's Information

Child's First Name *

Childs Last Name *

Sex *

Male

Female

Age *

Date of Birth * +

Ethnicity *

Allergies, Asthma, Or Medical Conditions? *

Need To Borrow Equipment? *

No

Yes

Shoe Size *

Choose your, Preferred Rink for Learn To Skate *

I understand that Hasek's Heroes equipment is not ours to keep. At the conclusion of the camp it will be returned for the next kid to use. *

Yes, we will return the equipment that was borrowed for the next kid to use

I understand that completing this form does not guarantee my acceptance into the program. I will receive a follow up email to confirm registration. *

Yes, I understand

Select Equipment Fitting Date *

New To Hasek's Heroes *

No

Yes

Parent/Guardian's Information

First Name *

Last Name *

Address *

City *

Zip/Postal Code *

Phone *

Email Address *

Email Address 2

Gross Household Income *

Household Size *

Emergency Contact

First Name *

Last Name *

Phone *

Relationship *

Parent/Guardian Agreement and Authorization

I, the custodial parent or guardian of the aforementioned candidate for the DHYHL hockey program hereby give my approval to his/her participation in any and all activities of this program during the 2021-2022 season. I assume all risks and hazards incidental to such participation, including transportation to and from such activities and do hereby waive, release, absolve, indemnify and agree to hold harmless the DHYHL, the organizers, supervisors, sponsors, participants and persons transporting my child to and from activities, for any claim arising out of an accident or injury to my child, except to the extent and in the event covered by accident and/ or liability insurance held by the DHYHL. I agree [give my permission for the player listed on this form] to be photographed, videotaped, or interviewed by any television, radio, newspaper, magazine, private person or group, and that the gathered material may be transmitted by electronic media or otherwise used in DHYHL published materials or in other ways for the enhancement of the DHYHL program. I have read this acknowledgement and do hereby demonstrate my understanding and agreement to abide by these guidelines by affixing my signature and the date below. Furthermore, I affirm that all the information provided on this form is true. I understand that if I knowingly give false statements, such action could be grounds for denial or dismissal from the Hasek's Heroes Program. *

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