2017 Summer Adult Hockey League
Captain Registration
AHL Division (check one):  A  B  C  40+A  40+B  40+C
 50+
 Bevi
If you are a captain for multiple teams, please fill out separate forms.
Team Name: ______________________________________
First Name: _______________________
Last Name: _____________________________
Check one: OK to include full name on AHL Division Page
Prefer First Name only
Email Address: ____________________________________
Phone: __________________
Preferred Method of contact by team (Check all that apply):
Note: This information will be posted on the AHL Division Page.
 Phone (call)
 Phone (text)
 Email
Jersey Color(s): _________________________
Additional information for new/prospective players: ________________________________
____________________________________________________________________________
____________________________________________________________________________
Thank you for volunteering to serve as captain of a team in the Adult Hockey League at Jacksonville Ice &
Sportsplex. By doing so, you understand and agree to all of the following:
• My name and contact information will be placed on the Jax Ice website on any and all AHL pages.
These pages may be accessible to the general public.
• I will complete and submit my team roster complete with jersey numbers & USA Hockey numbers
by June 1, 2017.
• I have read the JIS AHL Rulebook in it’s entirety.
• I agree to assist in enforcing the rulebook within my own team and the league as a whole.
Please submit completed forms to the Jax Ice Staff when you register for the league.
Thank You & Have A Great Season! -Jax Ice Hockey Department
FOR OFFICE USE ONLY:
 10% Discount applied
Initials: _____________