SAND SHARKS ICE HOCKEY
2017 SPRING - NEW PLAYER REGISTRATION
NEW PLAYER REGISTRATION:
Step 1: Please completely fill out “Registration Form”
Step 2: Choose Payment Method
Step 3: Scan/Email or Mail completed Registration Form and Payment to address/email below
Player Information
Parent Information
Name: ______________________________________
Father’s Name: ______________________________
Date of Birth: __________________
Email: ______________________________
Position: ______________________
Cell Phone No: ______________________________
USA Hockey Reg #: ____________________________
Mother’s Name: ______________________________
Email: ______________________________
Regular Season Team(s):
____________________________________________
Cell Phone No: ______________________________
Provide three (3) Jersey Numbers:
Address:
_________ _________
_________
Sand Shark Program
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Squirt A
Squirts AA
PeeWee A
PeeWee AA
Bantam
Midget U16
Midget U18
2008 Birth Year
2007 Birth Year
2006 Birth Year
2005 Birth Year
’04 - ’03 Birth Years
’02 - ’01 Birth Years
’00 - ’99 Birth Years
AGREEMENT and WAIVER:
I give my permission for my child to participate in the 6 AM Productions, Sand Sharks Ice Hockey Program and to receive
any and all medical attention necessary to be administered until such times as I can be contacted. The undersigned does
hereby authorize an officer, coach, or agent of the Sand Sharks Ice Hockey Program transport, as the child requires for any
medical attention. The undersigned does hereby assume all risks and hazards incidental to the child’s participation in
hockey, including but not limited to, transportation to and from all activities, and I do hereby waive, release, absolve,
indemnify and agree to hold harmless the 6 AM Productions and the Sand Sharks Ice Hockey Program its coaches,
sponsors, participants, and agents, from any and all claims arising out of injury to my son/daughter. I hereby discharge 6
AM Productions and the Sand Sharks Ice Hockey Program, Christian Hubert and employed from all damages, suit, cause
of action, or liabilities for personal injury and or property damages which may arise as a result of any such accident or loss.
By signing this agreement & waiver, it is also agreed that express permission is granted to 6 AM Productions and the Sand
Sharks Ice Hockey Program to use photographs and videos in which the players’ image and likeness appear in connection
with his/her participation in the Sand Sharks Ice Hockey Program. Said express permission shall apply to the display,
publication, distribution, use, print and reprint, online media of such images and likeness, and the right to employ such
images or likeness in advertising and promotions. All Deposits are Non-Refundable. Non Deposit portion of tuition is
refundable up to 45 days prior to program start date. After that date, we will provide tuition credit to our 2018 Spring season.
No refund or tuition credit will be provided for non participation due to injury or any other excuses for non participation.
____________________________________________
PAYMENT OPTIONS:
Midget U18 - $1,175
All Other Teams - $1,075
________ Cash/Check
(Deposit $525.00, Final Payment Due 3/1/17)
________ Credit Card #1
(Full Payment due immediately, no processing fee)
________ Credit Card #2
(Deposit $525.00 + $50 processing fee and Final Payment
due on 2/1/17 + $50 processing fee)
Email Form to: [email protected]
Mailing Address: 3137 Lincoln Avenue, Oceanside, NY 11572
SIGNATURE:
Check - Make Payable to: Sand Sharks Ice Hockey
X - _______________________________________________
Credit Card - Card #: _______________________________
Exp Date: ____/______ Security Code: _______
Zip Code: ______________