Yukon Aboriginal Sport Circle
Hockey Registration
Rural Community BC Hockey Membership and
Insurance Registration Form
Attached is a registration form for rural community youth and coaches if they do not have a Minor Hockey
Association in their Community that is an affiliate member of the British Columbia Hockey (BCAHA) or
Canadian Hockey Association (CHA).
All Hockey players to be eligible for and compete in the following events must be insured and members of
the BC Hockey:
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Note:
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Fee:
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CHA sanctioned events;
Canada Winter Games trails, ID Camps, practices and games;
Arctic Winter Games trials, ID Camps, practices and games;
Yukon Championships;
National Aboriginal Hockey Championships trials, practices and games;
Yukon Indian Hockey Association Youth and Jamboree Tournament
Other hockey related activities.
This registration process is for communities that do not have a Minor Hockey Association that is associated
with BC Hockey or CHA. Dawson City, Watson Lake, Haines Junction, Teslin and Whitehorse all have
Minor Hockey Associations that are affiliated with BC Hockey and CHA. Youth and Coaches in these
communities must register through their respective associations, this form does not replace that process it’s
just a membership and insurance process for communities that do not have the ability to register their own
youth.
This insurance and membership is needed for participation in Canada Winter Games Trails/ID Camps,
Games and Practices; Arctic Winter Games Trials/ID Camps, Games and Practices; Yukon Championships,
the National Aboriginal Hockey Championships, trials and practices; Yukon Indian Hockey Associations’
Youth Tournament and other hockey related activities.
The cost to register through the YASC Hockey Association is $50.00. This includes the BC Hockey
insurance and membership fee and YASC administrative fee.
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This fee does not include the cost of playing minor hockey in your community, trial fees, etc. Youth will still
have to pay the communities regular hockey fees and also register in your community if there is a process
to do this.
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Registration Form and Fee must be handed in before any youth steps on the ice for any of the above
events.
Coaches:
 All coaches must have their Speak Out or Respect in Sport certificate to be insured. The Respect in Sport
course is offered free of charge through Yukon Government at
https://yukon.respectinsport.com/secure/en/modules.jsp (see Respect in Sport instructions)
Yukon Aboriginal Sport Circle – Hockey Division
Registration Form for 2013– 2014 Hockey Season
BC Hockey Membership and Insurance
If there are any questions regarding this registration process, please contact
Cindy Underhill, YIHA Youth and Jamboree Native Hockey Tournament Coordinator at
867-863-5863 or email [email protected]
* Required field to be insured!
Member’s Profile:
*Player’s/Coaches Name:_____________________________________________
*Address: _________________________________________________________
*City/Town: _______________________Postal Code:______________________
*Phone or Contact Number: __________________________________________
Aboriginal Ancestry (not required to fill out):
*Age as of Dec. 31, 2013_________
Yes_________ No_________
*Birth Date: ____________________
(Day/Month/Year)
*Gender: Male:_________ Female: ________
Division: ___________
Position:_______________________
MHA 2012/2013: ________________
Goalie: Full Time: ______________
Part – Time: ___________________
Do you have your own Goalie Equipment?:
Yes: _____ No: _____
Parent/Guardian Information (Please list ALL Parent/Guardian Names!)
Parent/Guardian (s) : ________________________
Relation:_____________
________________________
Relation:_____________
Address: __________________________________________________________
Phone (h): _____________ Phone (w):_____________ Phone (cell): ___________
Email: _____________________________________________________________
YASC Registration Form for 2013– 2014 Hockey Season (page 1)
BC Hockey Membership and Insurance
Player’s/Coaches Name:_____________________________________________
Medical Information
Please list any medical concerns that the player has (i.e. allergies, medical conditions, previous injuries,
etc.):
___________________________________________________________________________________
___________________________________________________________________________________
_________________________________________________________________
*Health Care Insurance #: __________________Province/Territory Issued_________________
Emergency Contact: _______________________Emergency Phone #: ____________________
Parent/Guardian’s Signature: ___________________________________________
[email protected]
Payment Method by: Cash or Cheques ONLY
Please make Cheques payable to: Yukon Aboriginal Sport Circle
Individual Cheque
Cheque #: ________________
Community Minor Hockey Association or Community Recreation Association Cheque
Cheque #: ________________
Please send completed form to the following email or fax to:
Attention:
Email:
Fax:
Cindy Underhill - Youth and Jamboree Native Hockey Tournament Coordinator
[email protected]
867-456-7290
YASC Registration Form for 2013– 2014 Hockey Season (page 2)
BC Hockey Membership and Insurance