Tri-Valley
Roller Hockey League
Write Special Requests Here:
_______________________________
REGISTRATION FORM: PARENTAL CONSENT
WAIVER OF NEGLIGENCE INDEMNITY
AND HOLD HARMLESS AGREEMENT
Program/
Division _________________________
PLEASE PRINT ALL INFORMATION
LEAGUE USE ONLY
Players Name:_________________________________________________________
Last
First
Middle
Address:______________________________________________________________
Fee Paid ____________________
Cash
Check No._____
City:_________________________________________ Zip:_____________________
Contact email address:____________________________________________________________________________________________
Phone: (Home)_____________________ (Work/Cell) _________________________
M
F
Height:_____________ Weight:_____________
Date of Birth:_________________ _____________________
Mo. Day Year
Age on 01/01/2015
Jersey Size: YOUTH:____SM/MED ____LARGE/XL - ADULT: ___SM ___MED ___LRG ___XL ___XXL ___XXXL ___GC
Did you play in the Tri-Valley League last season?___________ Seasons played last 12 months? ___ None ___ Fall ___ Spring ___ Summer
Parent’s Name(s) (If players is under 18 years of age)
Home Phone No. ______________________________________
(Father)_______________________________________________ Work/Cell Phone No.___________________________________
Home Phone No._____________________________________
(Mother)_______________________________________________ Work/Cell Phone No.__________________________________
PARTICIPATION APPROVAL: WAIVER OF NEGLIGENCE: INDEMNITY AND HOLD HARMLESS AGREEMENT
I/We the parents/guardian of the above named applicant, hereby give My/Our approval to his/her participation in any roller hockey activities during the current season.
I/We do assume all risks and hazards incidental to such participation including transportation to and from such activities; and I/We do hereby waive, release, absolve,
indemnify, and agree to hold harmless the local team, the Tri-Valley Roller Hockey League, and any other organization that this roller hockey league is affiliated with,
the organizers, directors, sponsors, supervisors, managers, coaches, referees, participants, and persons transporting My/Our child to and from such activities, for any
claim arising out of injury to My/Our child.
_________________________________________________________________________________________________________________________
Father’s Signature
Mother’s Signature
Player/Guardian Signature
PARENTAL CONSENT AND AUTHORIZATION TO OBTAIN MEDICAL TREATMENT
My/Our child has the following physical handicaps, injuries or allergies: _____________________________________________________________________
_______________________________________________________________________________________________________________________________
In the event of injury to My/Our child (Print child’s full name)____________________________________________ Age ____________ who was born
on___________________. I/We hereby grant authority to any qualified physician to render such medical treatment as said physician deems necessary under the
circumstances. The name of our own and/or group insurance is _____________________________________________________. If there is no other insurance,
enter parent’s or guardian’s social security number__________________________________________.
I/We have read the foregoing Parental Consent and Authorization to obtain Medical Treatment. I/We understand and sign them voluntarily.
_________________________________________________________________________________________________________________________
Father’s Signature
Mother’s Signature
Player/Guardian Signature
ACKNOWLEDGEMENT OF ASSUMPTION OF RISK: WAIVER OF NEGLIGENCE: AGREEMENT TO
INDEMNIFY AND HOLD HARMLESS: STATEMENT OF PRESENT ABILITY
I/We know that playing roller hockey is a potentially hazardous activity. I/We should not enter this league unless I/We am medically able and properly trained.
I/We also assume any and all other risks associated with this league, including but not limited to falls, contact with other participants, the effects of weather,
including high heat and/or humidity, and the conditions of the rinks, all such rinks being known and appreciated by Me/Us. Knowing these facts, and in consideration of your acceptance of My/Our entry fee, I/We hereby for myself, my heirs, executors, administration or anyone else who might claim on my behalf,
covenant not sue, waive, release, and discharge any organization associated with the league, and any and all sponsors including their agents, employees, assigns or
anyone acting on their behalf from any and all claims or liabilities for death, personal injury or property damage of any kind or nature whatsoever arising out of, or
in the course of my participation in this league. This release and waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or
unknown. The undersigned further grants permission of this league and any organization conducting the league and/or agents authorized by them, to use any
photographs, videotapes, motion pictures, recordings or any other record of this league for any purpose.
I/We have read the foregoing and certify My/Our agreement by My/Our signature.
(Parents)___________________________________________________ (Participant)________________________________ (Date) ___/____/____
TVRHL CODE OF CONDUCT FOR ALL
PLAYERS, COACHES, PARENTS, AND
SPECTATORS
The Tri!Valley Roller Hockey League (TVRHL) is run and operated for the enjoyment of youths and adults participating in an athletic
event. Roller Hockey is a fun and exciting sport with lots of action on the rink as well as off the rink with parents and spectator
involvement. Our goal is for everyone involved to have a positive experience playing and watching roller hockey. Therefore, the TVRHL
would like all of our players, coaches, and parents to be familiar with our rule book, division guidelines and a few major rules that keep the
TVRHL safe and fun for everyone to enjoy.
1.
2.
PLAYER SAFETY HAS ALWAYS BEEN AND ALWAYS WILL BE OUR NUMBER ONE PRIORITY.
PROMOTING A “HAVE FUN AND ENJOY THIS GREAT SPORT” ATMOSPHERE IS OUR NUMBER TWO
PRIORITY.
3. A complete copy of our rules and division guidelines can be found on our web site http://www.tvrhl.com
4. ALL PLAYERS PAY… THEREFORE ALL PLAYERS PLAY. We want every player in every game to play about half of the
game. Every player must be included on specialty lines (power play and penalty kill lines) and be on the starting line on the rink
to begin at least one period. During a 20 minute period, the minimum playing time is at least 9 minutes of every period and the
maximum playing time is 16 minutes of every period. This will be enforced during all pre season games, regular season games,
and the Encore Sports Cup playoff games. Coaches must follow these playing time rules with 7 or more skaters during league
games. Any team in violation of this rule is subject to a forfeiture of that game.
5. FULL TVRHL REQUIRED ROLLER HOCKEY GEAR MUST BE WORN BY ALL PLAYERS DURING ALL
PRACTICES AND GAMES, NO EXCEPTIONS. Full roller hockey gear includes: HECC Certified helmet with full face
protection, mouthpiece, elbow pads, hockey gloves, girdle with cup, shin and knee guards, inline skates, and a hockey stick.
6. NO FOUL LANGUAGE by any player, coach, or spectator. Coaches are responsible for the conduct of their players and
spectators.
7. NO FIGHTING. The TVRHL does not tolerate fighting. Any player written!up for a fighting major by a referee will be ejected
from the TVRHL with no refund.
8. THREE PENALTIES IN THE SAME GAME WILL RESULT IN THAT PLAYER BEING EJECTED FROM THAT
GAME.
9. NO CHECKING, ROUGHING, SLASHING, HIGH STICKING, BOARDING, CROSS CHECKING, TRIPPING,
SLASHING, OR SHOOTING THE PUCK AFTER THE WHISTLE. Penalties will be called for these infractions. Please
refer to TVRHL rulebook.
10. USA Hockey “Standard of Play” initiative will be used with very strict enforcement. Go to www.tvrhl.com and click on
the “Standard of Play” button on the home page.
11. Each team is responsible for their own trash pick!up in the picnic area, player bench area and around the park at all times during
games and practices.
All coaches, players and spectators are hereby notified that league rules prohibit anyone from:
• Harassing any referee, player, opposing player, coach or league official.
• Coaches are responsible for the good conduct of their assistants, players and spectators.
Any coach or player violating the Code of Conduct is subject to:
• Immediate ejection from the game by referee in charge and subsequent suspension or disciplinary action from the Board of
Directors according to he league rules.
Any parent or spectator violating the Code of Conduct will be:
• Warned by the referee in charge that they are in violation of the league’s rules and its Code of Conduct.
In the event of a second violation of the Code of Conduct during the same game, the following will result:
• The referee in charge will inform the coaches and spectators that play will be suspended until the offending individual(s) leave the
facility.
• In the event that the offending individual(s) refuse to comply, the offending team will forfeit the game.
Remember: Good Behavior Does Not Cost Anything!!! However, it does pay – it allows the players, coaches, and spectators to enjoy a
game between kids or adults just for the fun of it!!!
I have read and understand all of the above:
Player’s printed name: _________________________________
Player’s Signature: _____________________________________
Parent’s printed name: _________________________________
Parent’s Signature: _____________________________________
Coach’s printed name: _________________________________
Coach’s Signature: ______________________________________