LOCATION
Chasco Family YMCA
Hockey Center
Equipment to be
provided by participant:
ROLL INTO
YOUR GAME
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Arena Hockey
Roller Hockey League
Shin Guards
Elbow Pads
In-line Roller Skates
Mouth Piece
BLACK Wind Pants
AGE DIVISIONS
6U Coed
YMCA OF GREATER WILLIAMSON COUNTY
(5-6 years of age as of
Mar. 12)
8U Coed
(7-8 years of age as of
Mar. 12)
ymcagwc.org
10U Coed
(9-10 years of age as of
Mar. 12)
• Each session includes seven (7) games and a Single Game Elimination Tournament
• Fee includes team jersey, one practice per week, and a participation medal
• Member Registration begins September 24th, Open Registration begins October 16th and runs through November
5th
• See reverse for further details or contact Kolbi Andresen at [email protected]
ARENA HOCKEY LEAGUE REGISTRATION
BIRTHDATE:
PLAYER NAME:
/
ADDRESS:
AGE AS OF 3/12/17:
CITY:
STATE:
PARENT NAME:
UNIFORM SIZE:
BEST CONTACT PHONE:
/
ZIP:
YXS YS YM YL AS AM AL
E-MAIL:
LOCATION SELECTION: ▢ ROUND ROCK
LEAGUE SELECTION: ▢ 6U Coed
(League is available to Cedar Park, Hutto and Burnet also)
▢ 8U Coed FEE
Interested in being a Goalie?
Yes No
Pleasenote,everyplayermayberequiredtoplaygoalieatleastonce
▢ 10U Coed
Interested in being a Head Coach?
Yes
No
SELECTION: ▢ $55 Member ▢ $115Non-Member
Request Information: (Please only choose one)
▢ Practice Day : ______________________________________________________
▢ Coach Request : __________________________________________________
▢ Friend Request : __________________________________________________
(Please do not put a time. We cannot honor time requests)
Y STAFF ONLY
Winter (17YS1) Amt. Paid:
EQUIPMENT TO BE PROVIDED BY PLAYER:
• SHIN GUARDS
• ELBOW PADS
• IN-LINE ROLLER SKATES
• MOUTH PIECE
• BLACK WIND PANTS
Date Received:
Staff Initials:
PROGRAM INFORMATION
Arena Hockey League Details
» Game length will be Four 8 minute quarters with open substitution. Running Clock.
» All practices and games will be held in the new Hockey Center, Located at 1500 N. Mays Street.
» One game and one practice per week.
» Games will be played between 8am and 8pm on Saturdays.
» Age of participants will be determined as of March 12th.
» Game setup: All Divisions Play 4v4 with a goalie
» Open substitution throughout the game.
aMust be in-line roller skates.
» Players must play a minimum of half the game.
» One (1) practice will be provided or arranged.
» Players must wear a jersey with a number on the back and all team jerseys must be the same (league provides)
» Only registered players with the YMCA are eligible to practice or play games.
» Uniforms are provide by the YMCA.
» All players and coaches must follow Y Guidelines (Coach's Conduct)
» Tournament Notes: All teams qualify for this one game tournament. Games will be four 8 minute quarters. Seeding is
based off overall record of season play.
League Rules:
»
»
»
»
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4 V 4 with a goalie. (Goalie equipment to be provided by the YMCA.
No offsides
No icing
No checking / fighting of any kind
Minimum of 4 players to start a game
Open substitution throughout the game
Four 8 minute quarters
1 timeout per game per team
PARTICIPANT WAIVER
Please INITIAL or ANSWER all lines to indicate received written policies / materials and agree to terms with SIGNATURE below.
Waiver for Medical Treatment (REQUIRED): In the event that my child requires emergency medical treatment, I hereby authorize the Y staff to
make arrangements to transport my child to the physician, hospital or clinic that I have designated or the nearest hospital / emergency medical
facility. I give my consent for any and all necessary medical care treatment for my child during this time.
Waiver for Participation (REQUIRED): I understand that Y activities have inherent risks and hereby assume all risks and hazards as a resultof
my child’s participation in all Y programs and facilities, including transportation to and from said activities. I further release, absolve, indemnify
and agree to hold harmless, the Y, the organizers, supervisors, directors, staff, volunteers, participants, coaches, referees, as well as persons or
parents transporting participants to or from such activities from any claims or injury sustained during my use of Y facilities or participation in any
Y activity, whether located on Y property or not.
Waiver for Photo / Video / Audio Release (OPTIONAL): I give my consent for any photos, video and/or audio taken of my child involved in Y
programs to be used for Y promotions, trainings and/or displays.
Change / Cancellation / Refund Policy (REQUIRED): I understand that the Y has a no refund policy. Details of the policy are available at the
Member Services Desk. Payment is due in full at the time of registration and in nonrefundable as well as nontransferable. Financial assistance is
available. For any questions, please contact any YMCA Member Services Desk.
X Signature:
YMCA OF GREATER WILLIAMSON COUNTY • 1812 N. Mays | Round Rock, TX 78664 • P 512.615.5511
Date:
ymcagwc.org